Methods of manufacturing nested balloons utilizing pressurized constrained annealing

ABSTRACT

A nested balloon is provided where each balloon is formed from tubing that optimizes the inner wall stretch thus providing maximum balloon strength. The high pressure, nested balloon is provided with layers that allow for slipping, such that the balloon has a very high pressure rating and toughness, yet excellent folding characteristics. Methods for producing such nested balloons using existing balloon forming equipment are also provided. The nested balloons can have layers with low-friction surfaces. The nested balloons are preferably manufactured using a variety of methods, including pressurized constrained annealing.

RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/924,278 filed Oct. 27, 2015, which claims priority under 35 U.S.C. §119(e) as a nonprovisional of U.S. Prov. Patent Application No.62/069,303 filed Oct. 27, 2014, the entire disclosure of the foregoingpriority applications are hereby incorporated by reference herein forall purposes in their entirety.

The entire disclosure of U.S. patent application Ser. No. 11/611,748filed Dec. 15, 2006, (now U.S. Pat. No. 7,942,847 issued May 17, 2011),is also incorporated by reference its entirety.

BACKGROUND Field

Embodiments relate generally to balloon catheters and methods for makingballoon catheters for medical applications. In particular, embodimentsrelate to a nested balloon having at least two balloons having differentproperties. The balloons may have multiple layers such as a layercomprising a low coefficient of friction.

Description of the Related Art

An increasing number of surgical procedures involve percutaneouslyinserted devices that employ an inflatable thin wall polymer balloonattached to the distal end of a small diameter hollow shaft called acatheter. The device can be advanced to the treatment site via anartery, vein, urethra, or other available passage beneath the skin. Theshaft usually exceeds 130 cm in length so that the balloon can bepositioned deep within the patient's body. The opposite (proximal) endof the shaft, typically having an inflation connector, remains externalto the patient.

When a balloon is advanced to a treatment site, the balloon is deflatedand tightly wrapped around the shaft to minimize its cross-section andfacilitate easy insertion and navigation through the passage. Afterreaching the desired location, the balloon is slowly inflated with ahigh pressure saline solution. The balloon walls unfold and expandradially. During this process a substantial radial force can be exertedby or on the balloon walls. This hydraulically generated radial forcecan be utilized for a number of different medical procedures such as,for example, vessel dilation, stent deployment, passage occlusion, andbone compression or distraction (such as distraction of vertebrae in thespinal column).

Several factors can limit the force a balloon can exert while within apatient. For example, for a particular cross-sectional balloon size, thedesign of a balloon, the material used to construct the balloon, and thestructural integrity of a balloon can limit the force a balloon canexert without failing (e.g., bursting). Minimizing the risk of balloonbursting can be important in many medical procedures because, uponbursting, balloon debris may become lodged within a patient causingpotentially severe trauma. Additional, higher pressures may be needed toaffect the treatment.

The hydraulically generated pressure, as noted above, typically exertstwo types of stress on the balloon. Radial stress (or hoop stress)pushes a cylindrically-shaped balloon radially outward. Radial stresscan lead to axial bursting of the balloon parallel to its longitudinalaxis. Axial stress, on the other hand, pushes a cylindrically-shapedballoon axially outward. Axial stress can lead to radial bursting of theballoon somewhere along the balloon's circumference (e.g., completefracture of the balloon).

Both radial stress and axial stress have a linear relationship inpressure to the balloon's wall thickness and the ratio of the balloon'sdiameter to the balloon's wall thickness. As a result, any increase inpressure or diameter size requires an equally proportional increase inthe balloon's thickness to avoid a critical pressure level (i.e., burstpressure) that will cause the balloon to burst. Generally, radial stressis twice as large as axial stress, so balloons will frequently burstaxially absent some deformity or preprocessing. However, in the presenceof balloon deformities, a balloon may burst radially. Such a radialbursting could disadvantageously leave separated sections of the ballooninside the patient after the catheter is removed.

Increasing balloon wall thickness also increases the cross-section ofthe balloon when deflated and wrapped for insertion. Consequently, aballoon having an increased balloon wall thickness might have limitedaccess to certain areas in a patient due to the balloon's increasedsize. Typically, the balloon's stiffness varies as a cube of theballoon's thickness. For example, doubling the balloon's wall thicknessto increase the burst pressure will increase the stiffness by a factorof eight. This added wall stiffness impairs one's ability to tightlywrap the balloon around the catheter shaft, which is necessary to limitthe size of the balloon's cross-sectional area. If the balloon is benttoo much beyond its stiffness, undesirable deformities may result.Usually, a balloon having a wall thickness of less than 0.0030 inchesmust be used to avoid the above-mentioned problems.

A number of techniques are being used to modify balloon properties inorder to improve balloon functionality. These techniques includeblending different types of polymers, adding plasticizers to balloons,and modifying parameters of the balloon forming process. These methodsare often not entirely successful in creating a more desirable balloonwith improved mechanical characteristics. Typically, these knowntechniques improve one balloon performance parameter while deterioratinganother parameter.

Some have attempted to resolve this problem by using multi-layerballoons. For the reasons described below, these prior art multi-layerballoons also have serious deficiencies.

SUMMARY

Disclosed in some embodiments are commercially viable, high pressure,nested balloon catheters. One aspect of embodiments involves creatingnested balloons. The nested balloon comprises at least two balloons,wherein each may have stretch properties that optimize the inner wallstretch thus providing maximum balloon strength. The nested balloonshave, in some cases, very high pressure ratings and toughness, yetexcellent folding characteristics. Methods for producing such nestedballoons using existing balloon forming equipment are also provided.

In some embodiments, a method of manufacturing a nested balloon isprovided. The method can include the step of providing a first balloonlayer. The method can include the step of providing a second balloonlayer. The method can include the step of inserting the first balloonlayer into the second balloon layer. The method can include the step ofannealing the first balloon layer and the second balloon layer in a moldat a temperature of between about 200° F. and about 270° F. for a timeperiod of between about 10 minutes and about 60 minutes. In someembodiments, annealing comprises pressurizing the nested balloon at apressure of between about 5 atm and about 30 atm and stretching theballoon with a stretch force of between about 1 pound and about 5pounds.

In some embodiments, the first balloon layer comprises nylon. In someembodiments, the second balloon layer comprises nylon. In someembodiments, the annealing temperature is between about 215° F. andabout 255° F. In some embodiments, the annealing temperature is about235° F. In some embodiments, the pressure is between about 15 atm andabout 25 atm. In some embodiments, the pressure is between about 15 atmand about 25 atm. In some embodiments, the stretch force is betweenabout 1 pound and about 2 pounds. In some embodiments, the time periodis between about 15 minutes and about 45 minutes. In some embodiments,the time period is between about 30 minutes. The method can include thestep of sterilizing the nested balloon after the annealing step at atemperature of between about 40° C. and about 60° C. for a time periodof between about 1 hour and about 3 hours. The method can include thestep of blow-molding the first balloon layer and the second balloonlayer prior to the annealing step, wherein the blow molding occurs nomore than about 48 hours prior to the annealing step. The method caninclude the step of blow-molding the first balloon layer and the secondballoon layer prior to the annealing step, wherein the blow moldingoccurs no more than about 24 hours prior to the annealing step. Themethod can include the step of welding the nested balloon to a cathetershaft to form a balloon catheter. In some embodiments, the first balloonlayer is a co-extruded balloon layer. In some embodiments, the secondballoon layer is a co-extruded balloon layer. In some embodiments, anested balloon having a plurality of layers (e.g., 2, 3, or more layers)that may be either co-extruded or non co-extruded layers can be formedvia methods as disclosed herein, including annealing the nested balloonunder a relatively high pressure.

In some embodiments, a nested balloon is provided. The nested ballooncan include a first balloon having an inner layer and an outer layer. Insome embodiments, each balloon layer of the first balloon has a firstbiaxial molecular orientation at its inner wall. The nested balloon caninclude a second balloon configured to be disposed within the firstballoon. The nested balloon can include a second balloon having an innerlayer and an outer layer. In some embodiments, each balloon layer of thesecond balloon has a second biaxial molecular orientation at its innerwall. In some embodiments, the expansion ratio of at least one of theinner wall of the inner layer and the outer layer of the first balloonare optimized such that the inner layer and the outer layer of the firstballoon resist further stretching. In some embodiments, the expansionratio of at least one of the inner wall of the inner layer and the outerlayer of the second balloon are optimized when disposed within the firstballoon such that the inner layer and the outer layer of the secondballoon resist further stretching. In some embodiments, the inner andouter layers of the first balloon and/or the second balloon are formedfrom co-extruded tubing. In some embodiments, the first balloon and thesecond balloon are formed from co-extruded tubing. In some embodiments,the average burst pressure is substantially greater than that of asingle balloon having the double wall thickness equal to combinedthickness of the first balloon and the second balloon.

In some embodiments, the expansion ratio of both of the inner walls ofthe inner layers and the outer layer of the first balloon are optimizedsuch that the inner layers and the outer layer of the first balloonresist further stretching. In some embodiments, the expansion ratio ofboth of the inner walls of the inner layers and the outer layer of thesecond balloon are optimized such that the inner layers and the outerlayer of the first balloon resist further stretching. In someembodiments, the first balloon and the second balloon are each formedfrom co-extruded tubing with at least two different materials havingdifferent stretch properties.

In some embodiments, the average burst pressure is at least about 10%,greater than that of a single balloon having the double wall thicknessequal to combined thickness of the first balloon and the second balloon.In some embodiments, the average burst pressure is at least about 25%greater than that of a single balloon having the double wall thicknessequal to combined thickness of the first balloon and the second balloon.In some embodiments, the average burst pressure is at least about 60%greater than for a single balloon having the double wall thickness equalto the combined thickness of the first balloon and the second balloon.In some embodiments, the average burst pressure is between about 25% andabout 75% greater than that of a single balloon having the double wallthickness equal to combined thickness of the first balloon and thesecond balloon.

In some embodiments, the average burst pressure is about or at leastabout 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%,70%, 75%, 80%, 85%, 90%, 95% or 100%, greater than that of a singleballoon having the double wall thickness equal to combined thickness ofthe first balloon and the second balloon. In some embodiments, theaverage burst pressure is between about 10%-20%, 15%-25%, 20%-30%,25%-35%, 30%-40%, 35%-45%, 40%-50%, 45%-55%, 50%-60%, 55%-65%, 60%-70%,65%-85%, 70%-80%, 75%-85%, 80%-90%, 85%-95%, or 90%-100%, greater thanthat of a single balloon having the double wall thickness equal tocombined thickness of the first balloon and the second balloon. In someembodiments, the average burst pressure is between about 10%-30%,15%-35%, 20%-40%, 25%-45%, 30%-50%, 35%-55%, 40%-60%, 45%-65%, 50%-70%,55%-75%, 60%-80%, 65%-85%, 70%-90%, 75%-95%, or 80%-100%, greater thanthat of a single balloon having the double wall thickness equal tocombined thickness of the first balloon and the second balloon. In someembodiments, the average burst pressure is between about 10%-40%,15%-45%, 20%-50%, 25%-55%, 30%-60%, 35%-65%, 40%-70%, 45%-75%, 50%-80%,55%-85%, 60%-90%, 65%-95%, or 70%-100%, greater than that of a singleballoon having the double wall thickness equal to combined thickness ofthe first balloon and the second balloon. In some embodiments, theaverage burst pressure is between about 10%-50%, 15%-55%, 20%-60%,25%-65%, 30%-70%, 35%-75%, 40%-80%, 45%-85%, 50%-90%, 55%-95%, or60%-100%, greater than that of a single balloon having the double wallthickness equal to combined thickness of the first balloon and thesecond balloon. In some embodiments, the average burst pressure isbetween about 10%-40%, 15%-45%, 200%-50%, 25%-55%, 30%-60%, 35%-65%,40%-70%, 45%-75%, 50%-80%, 55%-85%, 60%-90%, 65%-95%, or 70%-100%,greater than that of a single balloon having the double wall thicknessequal to combined thickness of the first balloon and the second balloon.In some embodiments, the average burst pressure is between about10%-100%, 15%-95%, 20%-90%, 25%-85%, 30%-80%, 35%-75%, 40%-70%, 45%-55%,greater than that of a single balloon having the double wall thicknessequal to combined thickness of the first balloon and the second balloon.

In some embodiments, the maximum hoop stress of the nested balloon issubstantially greater than that of a single balloon having the doublewall thickness equal to combined thickness of the first balloon and thesecond balloon. In some embodiments, the maximum hoop stress isapproximately 30% greater than for a single balloon having the doublewall thickness equal to combined thickness of the first balloon and thesecond balloon. In some embodiments, the maximum hoop stress isapproximately 40% greater than for a single balloon having the doublewall thickness equal to combined thickness of the first balloon and thesecond balloon. In some embodiments, the maximum hoop stress isapproximately 50% greater than for a single balloon having the doublewall thickness equal to combined thickness of the first balloon and thesecond balloon. In some embodiments, the maximum hoop stress is betweenabout 25% and about 55% greater than that of a single balloon having thedouble wall thickness equal to combined thickness of the first balloonand the second balloon.

In some embodiments, the maximum hoop stress is about or at least about5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%,75%, 80%, 85%, 90%, 95%, or 100%, greater than that of a single balloonhaving the double wall thickness equal to combined thickness of thefirst balloon and the second balloon. In some embodiments, the maximumhoop stress is between about 10%-20%, 15%-25%, 20%-30%, 25%-35%,30%-40%, 35%-45%, 40%-50%, 45%-55%, 50%-60%, 55%-65%, 60%-70%, 65%-85%,70%-80%, 75%-85%, 80%-90%, 85%-95%, or 90%-100%, greater than that of asingle balloon having the double wall thickness equal to combinedthickness of the first balloon and the second balloon. In someembodiments, the maximum hoop stress is between about 10%-30%, 15%-35%,20%-40%, 25%-45%, 30%-50%, 35%-55%, 40%-60%, 45%-65%, 50%-70%, 55%-75%,60%-80%, 65%-85%, 70%-90%, 75%-95%, or 80%-100%, greater than that of asingle balloon having the double wall thickness equal to combinedthickness of the first balloon and the second balloon. In someembodiments, the maximum hoop stress is between about 10%-40%, 15%-45%,20%-50%, 25%-55%, 30%-60%, 35%-65%, 40%-70%, 45%-75%, 50%-80%, 55%-85%,60%-90%, 65%-95%, or 70%-100%, greater than that of a single balloonhaving the double wall thickness equal to combined thickness of thefirst balloon and the second balloon. In some embodiments, the maximumhoop stress is between about 10%-50%, 15%-55%, 20%-60%, 25%-65%,30°10-70%, 35%-75%, 40%-80%, 45%-85%, 50%-90%, 55%-95%, or 60%-100%,greater than that of a single balloon having the double wall thicknessequal to combined thickness of the first balloon and the second balloon.In some embodiments, the average burst pressure is between about10%-40%, 15%-45%, 20%-50%, 25%-55%, 30%-60%, 35%-65%, 40%-70%, 45%-75%,50%-80%, 55%-85%, 60%-90%, 65%-95%, or 70%-100%, greater than that of asingle balloon having the double wall thickness equal to combinedthickness of the first balloon and the second balloon. In someembodiments, the maximum hoop stress is between about 10%-100%, 15%-95%,20%-90%, 25%-85%, 30%-80%, 35%-7.5%, 40%-70%, 45%-55%, greater than thatof a single balloon having the double wall thickness equal to combinedthickness of the first balloon and the second balloon.

Additionally, the nested balloon can have greater flexibility than thatof a single balloon having the double wall thickness equal to combinedthickness of the first balloon and the second balloon. In someembodiments, the flexibility is approximately 25% greater than for asingle balloon having the double wall thickness equal to combinedthickness of the first balloon and the second balloon. In someembodiments, the flexibility is approximately 50% greater than for asingle balloon having the double wall thickness equal to combinedthickness of the first balloon and the second balloon. In someembodiments, the flexibility is approximately 75% greater than for asingle balloon having the double wall thickness equal to combinedthickness of the first balloon and the second balloon. In someembodiments, the flexibility is between about 25% and about 75% greaterthan that of a single balloon having the double wall thickness equal tocombined thickness of the first balloon and the second balloon.

In some embodiments, the flexibility is about or at least about 5%, 10%,15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%,85%, 90%, 95%, or 100%, greater than that of a single balloon having thedouble wall thickness equal to combined thickness of the first balloonand the second balloon. In some embodiments, the flexibility is betweenabout 10%-20%, 15%-25%, 20%-30%, 25%-35%, 30%-40%, 3.5%-45%, 40%-50%,45%-55%, 50%-60%, 55%-65%, 60%-70%, 65%-85%, 70%-80%, 75%-85%, 80%-90%,85%-95%, or 90%-100%, greater than that of a single balloon having thedouble wall thickness equal to combined thickness of the first balloonand the second balloon. In some embodiments, the flexibility is betweenabout 10%-30%, 15%-35%, 20%-40%, 25%-45%, 30%-50%, 35%-55%, 40%-60%,45%-65%, 50%-40%, 55%-75%, 60%-80%, 65%-85%, 70%-90%, 75%-95%, or80%-100%, greater than that of a single balloon having the double wallthickness equal to combined thickness of the first balloon and thesecond balloon. In some embodiments, the flexibility is between about10%-40%, 15%-45%, 20%-50%, 25%-55%, 30%-60%, 35%-65%, 40%-70%, 45%-75%,50%-80%, 55%-85%, 60%-90%, 65%-95%, or 70%-100%, greater than that of asingle balloon having the double wall thickness equal to combinedthickness of the first balloon and the second balloon. In someembodiments, the flexibility is between about 10%-50%, 15%-55%, 20%-60%,25%-65%, 30%-70%, 35%-75%, 40%-80%, 45%-85%, 50%-90%, 55%-95%, or60%-100%, greater than that of a single balloon having the double wallthickness equal to combined thickness of the first balloon and thesecond balloon. In some embodiments, the flexibility is between about10%-100%, 15%-95%, 20%-90%, 25%-85%, 30%-80%, 35%-75%, 40%-70%, 45%-55%,greater than that of a single balloon having the double wall thicknessequal to combined thickness of the first balloon and the second balloon.

The outer layer of the first balloon can be configured to slide relativeto the inner layer of the second balloon. At least one of the innerlayers and the outer wall of the first balloon can include a stresscrack mitigating layer for the outer layer of the first balloon. In someembodiments, the inner layer comprises Pebax. The stress crackmitigating layer can have a lower coefficient of friction relative tonested balloons of the same material to permit sliding of the balloonsrelative to each other. The inner layer of the second balloon caninclude a stress crack mitigating layer. In some embodiments, the outerlayer of the first and the second balloon comprises Nylon and the innerlayer of the first and the second balloon comprises Pebax. In someembodiments, the ratio of Nylon to Pebax is about 70:30. In someembodiments, the outer layer of the first and the second ballooncomprises Nylon and the inner layer of the first and the second ballooncomprises Pebax. In some embodiments, the ratio of Nylon to Pebax isabout 60:40. In some embodiments, the outer layer of the first and thesecond balloon comprises Nylon and the inner layer of the first and thesecond balloon comprises Pebax. In some embodiments, the ratio of Nylonto Pebax is about 50:50. In some embodiments, the ratio of Nylon toPebax is between about 90:10-80:20, 80:20-70:30; 70:30-60:40 or60:40-50:50. In some embodiments, the ratio of Nylon to Pebax is betweenabout 90:10-70:30; 80:20-60:40, or 70:30-50:50. In some embodiments, theratio of Nylon to Pebax is between about 90:10-60:40 or 80:20-50:50.

In some embodiments, the neck of the first balloon is fused to a neck ofthe second balloon at a location spaced from the proximal end of acatheter. In some embodiments, at least one end of a neck of the firstballoon is staggered from the corresponding end of a neck of the secondballoon. In some embodiments, at least one end of a neck of the firstballoon is axially offset from the corresponding end of a neck of thesecond balloon.

In some embodiments, a method for creating a nested balloons for medicalapplications is provided. The method can include the step of providing afirst balloon having a first proximal neck and a first distal neck and asecond balloon having a second proximal neck and a second distal neck.The method can include the step of inserting the second balloon into thefirst balloon. The method can include the step of heating and stretchingthe first balloon to optimize the stretch of an inner wall of the firstballoon. The method can include the step of heating and stretching thesecond balloon to optimize the stretch of an inner wall of the secondballoon. In some embodiments, the second balloon has different stretchproperties than the first balloon.

In some embodiments, a method of making a nested balloon is provided.The method can include the step of selecting a first co-extruded tubularsection comprising a first inner layer and a first outer layer, thefirst inner layer and the first outer layer having either the same ordifferent materials with the same or different stretch properties. Themethod can include the step of selecting a second co-extruded tubularsection comprising a second inner layer and a second outer layer, thesecond inner layer and the second outer layer having the same ordifferent materials with the same or different stretch properties. Themethod can include the step of stretching each layer of the first andsecond co-extruded tubular sections to within approximately 15% of itsoptimal radial stretch, the optimal radial stretch for each layerdetermined based upon the inner surface of the layer. The method caninclude the step of positioning the first co-extruded tubular sectionwithin the second co-extruded tubular section to form a nested balloon.

In some embodiments, the stretching step is accomplished before thepositioning step. In some embodiments, the stretching step isaccomplished after the positioning step. The method can include the stepof fluting the first co-extruded tubular section. The method can includethe step of wrapping the first co-extruded tubular section. In someembodiments, the fluting and wrapping steps are accomplished before thepositioning step. In some embodiments, a radially inwardly facingsurface of the second inner layer is provided with a slip layer. In someembodiments, the slip layer comprises carbon nanoparticles. In someembodiments, at least one layer comprises nylon. In some embodiments,the second outer layer comprises nylon. In some embodiments, thestretching step comprises stretching each layer to within approximately10% of its optimal radial stretch. In some embodiments, the stretchingstep comprises stretching each layer to within approximately 5% of itsoptimal radial stretch. In some embodiments, the first co-extrudedtubular section and second co-extruded tubular section fail atapproximately the same pressure when a pressure is applied to the nestedballoon. In some embodiments, the first and second co-extruded tubularsections are configured to withstand at least about 40 atmospheres ofapplied pressure. In some embodiments, the first and second co-extrudedtubular sections are configured to withstand at least about 50atmospheres of applied pressure. In some embodiments, the first andsecond co-extruded tubular sections have substantially the same innerdiameter and substantially the same outer diameter.

In some embodiments, the average burst pressure is at least 30% greaterthan that of a single balloon having the double wall thickness equal tocombined thickness of the nested balloon. In some embodiments, theaverage burst pressure is at least 40% greater than that of a singleballoon having the double wall thickness equal to combined thickness ofthe nested balloon. In some embodiments, the average burst pressure isat least 50% greater than that of a single balloon having the doublewall thickness equal to combined thickness of the nested balloon. Insome embodiments, the average burst pressure is at least 60% greaterthan that of a single balloon having the double wall thickness equal tocombined thickness of the nested balloon. In some embodiments, themaximum hoop stress is at least 30% greater than that of a singleballoon having the double wall thickness equal to combined thickness ofthe nested balloon. In some embodiments, the maximum hoop stress is atleast 40% greater than that of a single balloon having the double wallthickness equal to combined thickness of the nested balloon. In someembodiments, the maximum hoop stress is at least 50% greater than thatof a single balloon having the double wall thickness equal to combinedthickness of the nested balloon. In some embodiments, the maximum hoopstress is at least 60% greater than that of a single balloon having thedouble wall thickness equal to combined thickness of the nested balloon.

In some embodiments, a method of making a nested balloon is provided.The method can include the step of selecting a first co-extruded ballooncomprising a first inner layer and a first outer layer, the first innerlayer and the first outer layer having different materials withdifferent stretch properties. The method can include the step ofselecting a second co-extruded balloon. The method can include the stepof expanding the first balloon to within approximately 15% of theoptimal radial stretch of an inner surface of the first inner layer. Themethod can include the step of expanding the second balloon to withinapproximately 15% of the optimal radial stretch of an inner surface ofthe second balloon. The method can include the step of nesting the firstco-extruded balloon within the second co-extruded balloon. In someembodiments, the first inner layer comprises a lower strength and lowerhardness material than nylon.

In some embodiments, a method of making a nested balloon is provided.The method can include the step of selecting a first co-extruded ballooncomprising a first inner layer and a first outer layer. The method caninclude the step of selecting a second co-extruded balloon comprising asecond inner layer and a second outer layer, the second inner layer andthe second outer layer having different material with different stretchproperties. The method can include the step of expanding the firstballoon to within approximately 15% of the optimal radial stretch of aninner surface of the first inner layer. The method can include the stepof expanding the second balloon to within approximately 15% of theoptimal radial stretch of an inner surface of the second inner layer.The method can include the step of nesting the first co-extruded balloonwithin the second co-extruded balloon. In some embodiments, the secondouter layer comprises nylon.

In some embodiments, a nested balloon is provided. The nested ballooncan include a first balloon having an inner layer and an outer layer,each balloon layer of the first balloon having a first biaxial molecularorientation at its inner wall. The nested balloon can include a secondballoon configured to be disposed within the first balloon, the secondballoon having an inner layer and an outer layer, each balloon layer ofthe second balloon having a second biaxial molecular orientation at itsinner wall. In some embodiments, the expansion ratio of the inner wallof at least one of the inner layers is substantially optimized such thatthe inner layer resists further stretching. In some embodiments, atleast one end of a neck of the first balloon is axially offset from thecorresponding end of a neck of the second balloon.

In some embodiments, the expansion ratio of both of the inner walls ofthe inner layers is optimized such that the inner layers a resistfurther stretching. In some embodiments, the first balloon and thesecond balloon are each formed from co-extruded tubing with at least twodifferent materials having different stretch properties. In someembodiments, the outer layer of the first balloon is configured to sliderelative to the inner layer of the second balloon. In some embodiments,at least one of the inner layers comprises a stress crack mitigatinglayer. In some embodiments, a neck of the first balloon is fused to aneck of the second balloon at a location spaced from the proximal end ofa catheter. In some embodiments, at least one end of a neck of the firstballoon is staggered from the corresponding end of a neck of the secondballoon. In some embodiments, the neck of the second balloon has a smalldiameter than the neck of the first balloon. In some embodiments, theneck of the second balloon has a longer length than the neck of thefirst balloon. In some embodiments, the neck of the second balloon isconfigured to be welded to a catheter. In some embodiments, the neck ofthe first balloon is configured to be welded to the neck of the secondballoon at a location along the neck of the second balloon.

In some embodiments, a method of making a nested balloon is provided.The method can include the step of selecting a first co-extruded tubularsection comprising a first inner layer and a first outer layer, thefirst inner layer and the first outer layer having different materialswith different stretch properties. The method can include the step ofselecting a second co-extruded tubular section comprising a second innerlayer and a second outer layer, the second inner layer and the secondouter layer having different materials with different stretchproperties. The method can include the step of positioning the firstco-extruded tubular section within the second co-extruded tubularsection to form a nested balloon. In some embodiments, at least one endof a neck of the first balloon is axially offset from the correspondingend of a neck of the second balloon.

The method can include the step of stretching each layer of the firstand second co-extruded tubular sections to within approximately 15% ofits optimal radial stretch, the optimal radial stretch for each layerdetermined based upon the inner surface of the layer. The method caninclude the step of fluting the first co-extruded tubular section. Themethod can include the step of wrapping the first co-extruded tubularsection. In some embodiments, a radially inwardly facing surface of thesecond inner layer is provided with a slip layer. In some embodiments,at least one layer comprises nylon. In some embodiments, the secondouter layer comprises nylon. In some embodiments, the first co-extrudedtubular section and second co-extruded tubular section fail atapproximately the same pressure when a pressure is applied to the nestedballoon. The method can include the step of welding the neck of thesecond balloon to a catheter. The method can include the step of weldingthe neck of the first balloon to the neck of the second balloon at alocation along the neck of the second balloon.

Another aspect comprises a nested balloon with two balloons having thesame or different material properties. In some embodiments, the outerlayer of at least one of the balloons can comprise a material of highstrength and hardness. In yet another aspect, the outer layer can bepolyamides, polyesters, polyethylenes, polyurethanes and their copolymers. One suitable material is polyamide (nylon). It will beapparent that further variations are possible involving structurallayers of other material or chemical composition.

In some embodiments, the inner layer of at least one of the balloons cancomprise a material of lower strength and hardness. One suitablematerial is Pebax (Arkema polyether block amide). Another aspectcomprises a balloon, wherein at least one layer of at least one of theballoons has at least one low friction surface. The inner layer of oneof the balloons can have a low coefficient of friction to advantageouslyallow sliding between adjacent balloons. As a result, flexibility of thenested balloon is increased over single balloons having an equal wallthickness. Other aspects involve a different number of structural layersfor each individual balloon, such as, for example, three structurallayers, four structural layers, and five structural layers.

Another aspect involves a nested balloon where each balloon has adifferent size (e.g., diameter and/or wall thickness). In someembodiments, each balloon is comprised of the same material or materialshaving substantially identical mechanical properties. In someembodiments, each balloon has the same degree of molecular orientationin the body portion of the balloon.

Another aspect involves a method for creating balloons with low frictioninterfaces by nesting multiple balloons. It will be apparent that thesemethods can be combined with each other and other balloon formingmethods to produce stronger balloons.

In one aspect, the bodies of the balloons can be formed separately onthe different molds to ensure that they have the proper size. The necksmay be specifically designed to ensure optimal welding and/or attachmentto the catheter. It will be apparent that other methods can be used. Itwill also be apparent that similar results can be achieved by making theouter balloon wider than the inner balloon.

In another aspect, separately formed balloons can be nested afteraltering the orientation of one balloon to make it thinner, facilitatinginsertion.

Balloons need not be formed and processed identically to obtainequivalent burst strengths, and/or molecular orientations. This isespecially true for balloons of different materials. Other suitablemethods can also be used to achieve uniform molecular alignment amongthe balloons.

In another aspect of some embodiments, already nested balloons can betreated as a single balloon. As a result, one can manufacture nestedballoons with a greater numbers of balloons (about or at least about 2,3, 4, 5, 6, or more balloons) than those specifically disclosed herein.

Some important parameters for performance assessment of high pressureballoon catheters include the rated burst pressure, the ballooncompliance, the size of the introducer, the flexibility of the foldedballoon section of the catheter and the production cost. In someembodiments, the rated burst pressure is about or greater than about 20,25, 30, 35, or more atmospheres. In some embodiments, the ballooncompliance is less than about five percent as measured between nominalpressure and rated burst pressure.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features, aspects, and advantages of the presentinvention will now be described in connection with preferred embodimentsof the invention shown in the accompanying drawings. The illustratedembodiments, however, are merely an example and are not intended tolimit the invention. The drawings are briefly described as follows:

FIG. 1A is a perspective view of an exemplary prior art ballooncatheter.

FIG. 1B is an enlarged perspective view of a cross-section of a priorart balloon catheter shaft.

FIG. 2 is a perspective view of a balloon catheter having a plurality offlutes.

FIG. 3A is a cross-sectional view of a fluted balloon catheter beforewrapping has been performed.

FIG. 3B is a cross-sectional view of a fluted balloon catheter afterwrapping.

FIGS. 3C through 3E are enlarged cross-sectional views of threedifferent fluted balloon catheters after wrapping.

FIG. 3F is an enlarged cross-sectional view of a fluted balloon catheterafter wrapping and compression.

FIG. 4 is an enlarged cross-sectional view of a fluted balloon catheterthat has developed a crack deformity upon wrapping.

FIG. 5 is a perspective view of a balloon catheter that has developed anaxial tear.

FIG. 6 is a perspective view of a balloon catheter that has developed afish-eye deformity.

FIG. 7A is an enlarged cross-sectional view of a fluted nested ballooncatheter after wrapping.

FIG. 7B is an enlarged cross-sectional view of a fluted single ballooncatheter after wrapping.

FIG. 8A is a cross-sectional view of a nested balloon catheter afterinflation.

FIG. 8B is a cross-sectional view of a single balloon catheter afterinflation.

FIG. 9 is a schematic showing the stretching of polymers to align theirmolecular chains through a blow molding process.

FIG. 10 is a stress-strain curve with strain, or the amount that aballoon will stretch during formation, on the x-axis and stress, or theapplied pressure, on the y-axis. FIG. 10 shows that once optimal stretchis achieved, a balloon material will have its greatest strength and willresist further growth.

FIG. 11 is a diagram illustrating the inner diameter stretch and theouter diameter stretch of single balloon tubing when expanded andshowing that the outer diameter stretch is less than the inner diameterstretch.

FIG. 12 is a stress-strain curve showing that when the inner wallstretch of single balloon tubing is optimized, the outer wall stretch issub-optimal and will continue to expand when applied pressure isincreased.

FIG. 13 is a diagram illustrating the inner and outer radii of singleballoon tubing in an unexpanded and an expanded state.

FIG. 14 is a graph showing single balloon catheters having diameters of2 mm, 4 mm, 6 mm, 8 mm, and 10 mm with wall thickness on the x-axis andthe ratio of outer wall stretch to inner wall stretch on the y-axis.

FIG. 15 is a schematic showing the wall profile of a single ballooncatheter that is represented in the graph of FIG. 16.

FIG. 16 is a graph of a single balloon catheter showing the relativestretch ratio as a function of wall slice with wall position on thex-axis and percentage of inner balloon stretch on the y-axis.

FIG. 17 is a graph of a single balloon catheter showing the relativewall strength with wall thickness on the x-axis and wall thicknessadjusted by the relative ratio of outer wall stretch to inner wallstretch on the y-axis.

FIG. 18 is a schematic showing the inner/outer stretches for nestedtubing of the same material in forming a dual layer balloon.

FIG. 19 is a graph of the inner stretch of wall slices of the nestedballoon having two non-identical balloons formed from the nested tubingfrom FIG. 18 in which inner wall stretch is not optimized on the outerextrusion relative to the inner stretch of corresponding wall slices ofthe single balloon.

FIG. 20 is a stress-strain curve with strain, or the amount that aballoon will stretch during formation for the nested tubing of FIG. 18,on the x-axis and stress, or the applied pressure, on the y-axis. FIG.20 shows optimal stretch is only achieved for the inner wall of theinner balloon.

FIG. 21 is a graph of numerous balloon lots showing average burstpressure increasing with thickness with double wall thickness on thex-axis and average burst pressure on the y-axis.

FIG. 22 is a graph showing maximum hoop stress of the balloon lots shownin FIG. 21 deviating from the maximum hoop stress of a uniform materialwith double wall thickness on the x-axis and hoop stress on the y-axis.

FIG. 23 is the graph of FIG. 21 showing average burst pressure deviatingfrom the average burst pressure of a uniform material with double wallthickness on the x-axis and average burst pressure on the y-axis.

FIG. 24 is a diagram illustrating the inner diameter stretch and theouter diameter stretch of coextruded tubing from materials possessingdifferent maximum stretch properties to form a dual layer balloon.

FIG. 25 is the graph from FIG. 21 with the addition of a nested balloonwith double wall thickness on the x-axis and average burst pressure onthe y-axis.

FIG. 26 is the graph of FIG. 22 with the addition of a nested balloonwith double wall thickness on the x-axis and hoop stress on the y-axis.

FIG. 27 is a graph of a single balloon catheter and dual-layer ballooncatheter manufactured from tubing in which the inner wall stretch hasbeen optimized for maximum strength. Both the single balloon anddual-layer balloon have the same overall wall thickness. The dual-layerballoon can be a nested balloon or a balloon which is blown fromextruded tubing as shown in FIG. 24. FIG. 27 shows the inner stretch ofwall slices of each layer of the dual-layer balloon relative to theinner stretch of corresponding wall slices of the single balloon.

FIG. 28A is a perspective view of a balloon catheter having an elementshown aligned in a longitudinal direction and in a lateral direction.

FIG. 28B is an enlarged perspective view of the longitudinally-alignedelement of the balloon catheter as shown in FIG. 28A.

FIG. 29A is a diagram of an element with a small thickness bending likea cantilevered beam shown with an applied force and a maximumdeflection.

FIG. 29B is a diagram of an element with a large thickness bending likea cantilevered beam shown with an applied force and a maximumdeflection.

FIG. 29C is a diagram of an element comprising three balloons eachhaving small thicknesses bending like a cantilevered beam shown with anapplied force and a maximum deflection.

FIG. 29D is an enlarged side elevational view of the element shown inFIG. 29C.

FIG. 30A is a side elevational view of an inner balloon used in a methodfor nesting balloons to form a nested balloon.

FIG. 30B is a side elevational view of the inner balloon after heatingand stretching (shown exaggerated) of the method for nesting balloons ofFIG. 30A.

FIG. 30C is a side elevational view of the inner balloon after flutingof the method for nesting balloons of FIG. 30A.

FIG. 30D is a side elevational view of a nested balloon wherein theinner balloon is inserted into the outer balloon used in the method fornesting balloons of FIG. 30A.

FIG. 31 is a side elevational view of a catheter with a nested balloon.

FIG. 32A is a side elevational view of a balloon weld configured for asingle balloon with equivalent strength.

FIG. 32B is a side elevational view of a balloon weld configured formulti-layer balloons.

FIG. 32C is a side elevational view of a balloon weld configured fornested balloons.

FIGS. 33A-33B are graphs of a single balloon catheter and nested ballooncatheter illustrating and comparing the superior and unexpected wallstretch properties of a nested balloon comprising a co-extruded innerlayer and a co-extruded outer layer at a given wall thickness withrespect to a single layer balloon having the same wall thickness. Asnoted, each balloon in the nested balloon catheter is dual-layer balloonmanufactured from co-extruded tubing. Both the single balloon and nestedballoon have the same overall wall thickness. FIG. 33A shows anembodiment where the stress crack mitigating inner layer is notoptimized. FIG. 33B shows an embodiment where the stress crackmitigating inner layer is optimized.

FIG. 34 is a graph of standard deviation for the average burst pressureof nylon balloons, according to some embodiments.

FIG. 35 is a graph of compliance of nylon balloons, wherein complianceis the percent change in balloon diameter from the nominal pressure tothe Rated Burst Pressure, according to some embodiments.

FIG. 36 is a graph of compliance of a nested balloon showing that theinitial diameter for calculating the standard balloon compliance islower, resulting in a greater compliance value, according to someembodiments.

FIG. 37 is a graph of the change in diameter due to a change in pressurefor non-annealed nested balloons, according to some embodiments.

FIG. 38 is a graph of the change in diameter due to a change in pressurefor annealed nested balloons, according to some embodiments.

DETAILED DESCRIPTION

Embodiments of the present invention will now be described more fullyhereinafter with reference to accompanying drawings, in which preferredembodiments are shown. This invention may, however, be embodied in manydifferent forms and should not be construed as limited to theembodiments set forth herein; rather, these embodiments are provided sothat this disclosure will be thorough and exemplary of the scope of theinvention to those skilled in the art.

FIGS. 1A and 1B show an exemplary embodiment of a prior art ballooncatheter system 1. A balloon 2 is attached to the distal end of acatheter shaft 3 and is inflated through an inflation lumen 4. A guidewire lumen 5 is provided on the catheter system 1, which allows forexternal control of the balloon 2 and the catheter 3 when the system 1is disposed within a patient. It should be noted that further variations(e.g., rapid exchange, concentric lumen, etc.) are possible for thisstructure.

FIG. 2 illustrates a perspective view of an embodiment of a prior artcatheter balloon 2 in an unwrapped and deflated configuration. Theballoon 2 is folded into a plurality of flutes 6, typically ranging fromthree to eight flutes. The plurality of flutes 6 are formed in adirection substantially parallel to a longitudinal direction of theballoon 7. The plurality of flutes 6 are folded with a slight curvaturein order to facilitate subsequently wrapping the fluted balloon 2 aroundthe catheter shaft 3 (as shown in FIG. 1A). The balloon 2 attaches tothe catheter shaft 3 both at a proximal neck of the balloon 50 and at adistal neck of the balloon 51. The balloon 2 also includes a bodyportion 52, which can be inflated and deflated when the balloon 2 isdisposed within the body of a patient during a particular medicalprocedure.

FIG. 3A shows a cross-section of an embodiment of a prior art flutedballoon 2 on a catheter shaft 3. The fluted balloon 2 has a plurality offlutes 6. In the illustrated embodiment, the plurality of flutes 6comprises six flutes. The deflated fluted balloon 2 has a relativelysmall cross-sectional area, but can have a relatively wide diameterbecause the thin flutes 6 stretch radially outward from the cathetershaft 3. Upon inflation, the balloon 2 can expand to have a much largerdiameter and cross-sectional area 8, as shown in the circular phantomlines in FIG. 3A.

FIG. 3B shows a cross-section of an embodiment of a prior art flutedballoon 2 after it has been wrapped. The plurality of flutes 6 arefolded down and about the catheter shaft 3 such that they are in closecontact with each other and the catheter shaft 3. Once the balloon 2 iswrapped, the deflated balloon's diameter and cross-sectional area 9(sometimes referred to as the crossing profile) is much smaller than theinflated balloon's diameter and cross-sectional area 8 (as seen in thecircular phantom lines in FIG. 3B). Having a balloon 2 with a smalldiameter and cross-sectional area 9 allows the catheter 2 to be guidedthrough smaller passageways within a patient's body. Inflating theballoon 2 to have a larger diameter and cross-sectional area 8advantageously allows for the placement of a larger stent, occlusion ofa larger passageway, and generally greater versatility once the catheter2 has reached a particular treatment site within a patient's body.

FIGS. 3C through 3E generally illustrate enlarged views of severalconfigurations of balloon folding patterns. FIG. 3C illustrates anenlarged side elevational view of a cross-section of a prior art flutedballoon 2 c after wrapping. As shown in FIG. 3C, the reduction in sizeof the wrapped balloon 2 c about the catheter shaft 3 is limited by theballoon's bend radius 10 c. In general, a balloon's bend radiusincreases with the thickness and toughness of the balloon, as can beseen by comparing FIG. 3C with FIGS. 3D and 3E. FIG. 3D shows a balloon2 d that is thicker than the balloon 2 c shown in FIG. 3C. As can beseen in FIG. 3D, the bend radius 10 d for the thicker balloon 2 d islarger than the bend radius of the balloon 2 c in FIG. 3C. FIG. 3E showsa balloon 2 e having the same thickness as the balloon 2 c of FIG. 3C,but being composed of a tougher or less flexible material than that ofthe balloon in FIG. 3C. As can be seen in FIG. 3E, the bend radius 10 efor the tougher balloon 2 e is also larger than the bend radius of theballoon 2 c in FIG. 3C. Accordingly, both a thicker balloon 2 d and atougher balloon 2 e typically cannot be folded into as small across-section as the balloon 2 c of FIG. 3C. The bend radius of aballoon is important because bending a balloon beyond its bend radiuscan cause deformities which will lower the balloon's resistance tobursting when inflated.

FIG. 3F shows a balloon 2 f wrapped about a catheter shaft 3. Theballoon 2 f has a negligible bend radius and can, therefore, be tightlywrapped about the catheter shaft 3 without any protrusions developing onthe outer surface of the folded and wrapped balloon 2 f. Advantageously,this configuration permits the diameter and the cross-section of theballoon 2 f to be minimized prior to, and during, insertion of theballoon catheter system into a patient's body. In addition, as discussedin further detail below, this configuration minimizes failure of theballoon 2 f during a medical application due to a deformity developingon the balloon's outer surface.

FIGS. 4 through 6 generally show deformities that can develop on aballoon's outer surface. As shown in FIG. 4, a wrapped balloon 2 isfolded and compressed beyond its bend radius 10 creating a crack 11 inthe outer surface of the wrapped balloon 2 near the site of a fold. Suchcracking is more likely for less compliant materials, which alsogenerally have higher burst strengths. Thus, there is a general tradeoffbetween burst strength and flexibility. Once the crack 11 has formed,stress will concentrate near the crack 11 when the balloon 2 isinflated, causing the crack 11 to expand and ultimately causing failureof the balloon 2 (e.g., by bursting).

FIG. 5 shows another deformity that occurs in balloons. When a medicaldevice such as a stent is applied over a balloon 2, it can create ascratch or axial tear 12. The scratch or axial tear 12 generally extendsin the longitudinal direction of the balloon 2. Again, the likelihood ofscratching can be minimized by using a more compliant material, whichalso has a lower burst strength. Once the scratch 12 has formed, stresswill concentrate near the scratch 12 when the balloon 2 is inflated,causing the scratch 12 to expand and ultimately causing failure of theballoon 2 (e.g., by bursting).

FIG. 6 illustrates yet another type of deformity. When a balloon isformed, there may be regions of low molecular density or imperfectionsin the molecular lattice. As a result, a small hole 13 can form uponstretching the balloon 2. The hole 13 can grow as the balloon 2 isstretched further, often resembling a “fish-eye.” Stress concentratesnear the edges of the fish-eye deformity 13. Since the balloon 2 isstretched during inflation, this can also lead to failure of the balloon2 (e.g., by bursting).

FIGS. 7A and 8A show an enlarged cross-section of an embodiment of anested balloon 2 having a first balloon 20, a second balloon 22, and athird balloon 24. Each balloon can be formed by the same process or adifferent process. In some embodiments, one or more of the first balloon20, the second balloon 22, and the third balloon 24 are formed fromparisons or co-extrusion. While the nested balloon 2 is shown with threeballoons, 20, 22, 24, other configurations are contemplated (e.g., twoballoons, four balloons, five balloons, six balloons, etc.)

In some embodiments, in which the nested balloon 2 comprises multipleballoons, one or more of the balloons can comprise one, two, or morelayers, as described herein. In some embodiments, each balloon in anested balloon can comprise one or more layers. In some embodiments,each balloon in a nested balloon can comprise two or more layers. Insome embodiments, two or more layers of the same balloon have differentproperties. In some embodiments, two or more layers of the same balloonhave the same properties. In some embodiments, two or more layers of asingle balloon are bonded together. In some embodiments, two or morelayers of a single balloon are integrally formed.

The properties of the layer can depend on the location of the layerwithin the nested balloon. For instance, the first balloon 20 cancomprise an outer layer, such as a material of high strength andhardness. The first balloon 20 can comprise an inner layer, such as amaterial having a low coefficient of friction. The outer layer and theinner layer can be bonded together. Other layers can be disposed betweenthe outer layer and the inner layer of the first balloon 20. Each layercan have an inner wall. The properties of the inner wall can beoptimized, as disclosed herein. The material selection of the layers ofthe first balloon 20, the second balloon 22, and the third balloon 24are described in greater detail herein.

The nested balloon 2 is shown in the wrapped position in FIG. 7A. Thewrapped position is described with respect to FIGS. 3A and 3B. Incomparison, a single balloon 2′ is also shown in the wrapped position inFIG. 7B. The cumulative thickness of the balloons 2, 2′ shown in FIGS.7A and 7B are equal.

In some embodiments with three balloons, the first balloon 20 of thenested balloon 2 has a thickness that is approximately one-third thethickness of the single balloon 2′ shown in FIG. 7B. The second balloon22 and the third balloon 24 also each have a thickness that isapproximately one-third the thickness of the single balloon 2′ shown inFIG. 7B. In other embodiments, the balloons 20, 22, 24 have unequalthicknesses that equal the cumulative thickness of the single balloon2′. While three balloons 20, 22, 24 are shown in FIG. 7A, otherconfigurations are possible, such as two balloons or four balloons. Insome embodiments, each balloon of a two balloon nested balloon 2 hasone-half the thickness of the single balloon 2′. In some embodiments,each balloon of a four balloon nested balloon 2 has one-fourth thethickness of the single balloon 2′. Because each balloon 20, 22, 24 ofthe nested balloon 2 is thinner than the single balloon 2′ of FIG. 7B,the bend radius 10 is smaller. Because the cumulative thickness of thenested balloon 2 of FIG. 7A is substantially the same as the thicknessof the single balloon 2′ of FIG. 7B, the burst pressure P could in somecases be the substantially the same as long as adjacent balloons 20, 22,24 of the nested balloon 2 can slide relative to each other. However, insome embodiments, depending on the materials and other parameters andthe desired clinical result the burst pressure of a nested balloon canbe greater than the single balloon having the same cumulative thickness.

In some embodiments, a nested balloon 2 comprises a first balloon 20 anda second balloon 22 but not the third balloon 24. In some embodiment,the first balloon 20 has one-half the thickness of the single balloon 2′and the second balloon 22 has one-half the thickness of the singleballoon 2′. Because each balloon 20, 22 is thinner than the singleballoon 2′ of FIG. 7B, the bend radius 10 is smaller.

As shown in FIGS. 7B and 8B, the single balloon 2′ has a total thickness3t that is equivalent the thickness of the nested balloon 2 shown inFIGS. 7A and 8A. In this example, each balloon 20, 22, 24 has athickness t. As shown in FIG. 7B, the single balloon 2′ has a largerbend radius 10′, and thus cannot be folded as closely to the cathetershaft 3. In FIG. 7A, adjacent balloons 20, 22, 24 of the nested balloon2 can slide relative to each other. The nested balloon has a smallerbend radius, and thus can be folded closer to the catheter shaft 3.

Because the nested design is more flexible, as discussed below,deformities as shown in FIGS. 4-6 are less likely to occur. Further, thematerial of the balloon or the material of the layers of the nestedballoon 2 can be selected to reduce the risk of deformities. In someembodiments, the first balloon 20 or the outer layer of the firstballoon 20 can resist scratches.

Meanwhile, the burst pressure P for a nested balloon 2 is substantiallygreater as will be shown as that for an equivalent thickness singleballoon 2′, as described herein. It will be apparent that similareffects can be achieved by varying the material in each balloon layer,varying the number of balloons, and varying other aspects of thisembodiment.

In some embodiments, the first balloon 20 of the nested balloon 2 has anouter layer which is preferably scratch and puncture resistant. When adevice such as a stent is applied to the catheter system, it istypically crimped onto the nested balloon 2. The applied crimping forceshould be such as to provide a sufficiently strong attachment force, yetit should also not scratch, pierce, or otherwise damage the nestedballoon 2. By selecting the material of the first balloon 20 or theouter layer of the first balloon 20, (which can comprise an outersurface of the nested balloon 2), the risk of failure due to scratchingcan be decreased.

The second balloon 22 and the third balloon 24 (which comprise innerballoons of the nested balloon 2) can be made of the same material asthe first balloon 20 or a different material than the first balloon 20.In some embodiments, the second 22 and the third balloon 24 comprise thesame material. These balloons 22, 24 can be protected from scratching bythe first balloon 20, and can provide additional strength to the nestedballoon 2. It should be noted that the above-described effects need notalways be achieved simultaneously, and they are not necessarilysensitive to the number of balloon, composition of other balloon, formof device carried by the catheter, or other aspects of this embodiment.

As is discussed in greater detail below, each balloon 20, 22, 24 may bedifferently sized and shaped in the body portion, in order to optimizethe burst characteristics of the balloon. As the nested balloon 2 isinflated, each balloon 20, 22, 24 is stretched, causing the thickness ofeach balloon 20, 22, 24 to shrink. The nested balloon 2 can be designedsuch that the inner wall of each balloon 20, 22, 24 reaches the point ofoptimal stretch, as described herein. When the inner wall of eachballoon 20, 22, 24 reaches the point of optimal stretch, the stretch ofthe outer wall of each balloon 20, 22, 24 is more optimal than the outerwall of the single balloon 2′. Referring back to FIGS. 7A and 7B, eachballoon 20, 22, 24 is has a thickness t and the single balloon 2′ has athickness 3t. There is a smaller gradient of stretch from the inner wallto the outer wall of each balloon 20, 22, 24 than the gradient ofstretch from the inner wall to the outer wall of the single balloon 2′.

In some embodiments, incorporating different material for each of theballoons 20, 22, 24 can allow the nested balloon 2 reach the optimalstretch of each inner wall at the required diameter. In someembodiments, incorporating different sizes for each of the balloons 20,22, 24 can allow the nested balloon 2 reach the optimal stretch of eachinner wall at the required diameter. In some embodiments, the design ofeach layer of each balloon 20, 22, 24 can allow the nested balloon 2reach the optimal stretch of each inner wall at the required diameter.

In the nested configuration, the inner wall of the first balloon 20needs to stretch to a distance between the diameter of the tube(deflated) and the required diameter (inflated). The inner wall of thesecond balloon 22, disposed inside the first balloon 20, needs tostretch to a larger distance than the first balloon 20 between thediameter of the tube (deflated) and the required diameter (inflated).The inner wall of the third balloon, if present, disposed inside thesecond balloon 22, needs to stretch to a larger distance than the firstballoon 20 and the second balloon between the diameter of the tube(deflated) and the required diameter (inflated).The inner wall of thethird balloon 24, if present, needs to stretch the greatest distance.The configuration is shown in FIG. 8A. The balloons 20, 22, 24 can beformed from the same, or different diameter tubing to allow tailoring ofthe stretch of the inner wall of each balloon. The balloons 20, 22, 24can be formed from the same, or different materials to allow tailoringof the stretch of the inner wall of each balloon.

With reference to FIGS. 9 and 10, an objective of blow molding inballoon formation is to stretch the polymer material in order to achievemaximum strength and semi-compliance. In blowing molding balloons usedin high pressure PTA and PTCA catheters, the intent is to stretch thetubing polymer in biaxial fashion so as to align the polymer moleculesalong the length and circumference of the balloon. This alignment of themolecular chains is shown in FIG. 9. During the stretching process, thematerial will grow until the polymer chains are aligned. Once thepolymer chains are aligned, the material resists further growth andprovides maximum strength. Such orientation provides the greateststrength for the material and resistance to further stretching. Theextreme strength of thin polymer films that form balloons comes frombiaxial molecular orientation. The ultimate tensile strength of fullyoriented material increases by a factor of four to five as compared toas-extruded tubing. The extent of molecular orientation is proportionalto amount of stretch (e.g., deformation, strain) imparted to the wallsof the balloon.

Theoretically there is an optimal stretch for each material. This isshown on the idealized stress-strain curve in FIG. 10. In response tothe strain caused by stretching, the material exhibits relatively evenstress, shown by the flat region in FIG. 10. Once the polymer chains arealigned at the optimal stretch point, the material resists furthergrowth as shown by an increase in stress. In the ideal cases, allpolymer chains will be uniformly stretched at the optimal stretch point.Various polymer materials will have different ideal stretch ratios inorder to achieve uniform molecular alignment. For instance, if the tubeis under-stretched, such as any point along the flat region shown inFIG. 10, then the polymers do not achieve the optimal alignment andstrength. Pressurizing such a balloon will result further growth andstretch of the polymer chains in an uncontrolled fashion, especially inabsence of proper temperature and dimensional control. The expectedresult is reduced burst pressure, reduced fatigue (ability to inflate tomaximum pressure repeatedly) and lack of recovery in compliance. Forinstance, if the tube is over-stretched, such as any point above theoptimal stretch point, the polymers become strained, resulting inbursting at lower pressures and reduced fatigue.

Optimum stretch for a balloon is dependent upon a number of variables.For a given material, there is a calculated optimum stretch thatprovides optimum strength of the balloon. The calculated optimum stretchis dependent upon, for example, the diameter of the balloon and thethickness of the layers which comprise the balloon. Practically, it canbe very difficult to stretch a balloon to its exact optimum stretch.Thus, for most applications, stretching a material to within 15% of itsoptimum stretch, such as to within less than 10%, will provide optimumballoon strength.

During the balloon forming process, the polymer material is stretchedboth radially and longitudinally in order to achieve biaxial orientationof the polymer chains. As balloons are typically cylindrical, there aretwo key areas of stress that come into play. The first key area ofstress is hoop or radial stress, resulting from pressure aligned alongthe circumference of the cylinder. Hoop stress of the inflated balloonequals the pressure multiplied by the radius of the inflated balloondivided by the thickness of the inflated balloon. The polymer stretcharound the circumference of the balloon provides strength againstbursting from hoop stress. The polymers act much like the bands around abarrel to prevent bursting. The second key area of stress is axial orlongitudinal stress, which is aligned along the central axis. Axialstress of the inflated balloon equals the pressure multiplied by theradius of the inflated balloon divided by twice the thickness of theinflated balloon. Therefore, hoop or radial stress is twice that ofaxial or longitudinal stress. As a result, optimizing the radial stretchis more important to burst resistance than longitudinal stretch. Formedical balloons, the critical attribute is often the maximum hoopstrength.

With reference to FIGS. 11 and 12, radial stretch confounds the goal toachieve a uniform stretch of the polymer material. The reason for thisis that balloons are blow molded from tubing having thicker walls. Asshown in FIG. 11, a confounding factor in balloon forming is that thestretch of the circumference of the inner wall of the tubing to theinner wall of the inflated balloon will always be greater than that ofthe outer wall of the tubing to the outer wall of the inflated balloon.The difference in wall thickness between the tubing and the inflatedballoon will cause the stretch of the inner wall of the initial tubingto be greater than that of the respective outer wall. This disparitybetween the stretch of the inner wall and the outer wall increases withthe increase in the thickness of the initial tubing.

In some embodiments, the outer wall of the balloon will have a lowerlevel of molecular orientation than the inner wall of the same balloon.The lower level of molecular orientation of the outer wall is related tothe shorter distance from outer diameter of the tube to the balloon moldwall as compared to distance from inner diameter of the tube to balloonmold wall (assuming thickness of the balloon is negligible). Forexample, a balloon is produced from nylon tubing having an outerdiameter of 0.031 and an inner diameter of 0.019. The mold has an innerdiameter of 0.118 and the thickness of the balloon is negligible wheninflated for ease of calculation. The expansion ratio for the outer wallis 3.8 (0.118/0.031) and the expansion ratio of the inner wall is 6.2(0.118/0.019).

The mold can be designed such that the inner wall reaches full molecularorientation. In the example above, let us assume that full molecularorientation occurs at an expansion ratio of 6.2. The outer wall whichonly expanded by a ratio of 3.8, not the optimal 6.2, has not reachedfull molecular orientation. A thicker tubing causes a greater disparityin the level of molecular orientation between the outer wall and theinner wall. A thinner tubing causes, in some cases, less disparity inthe level of molecular orientation between the outer wall and the innerwall. The smaller the difference between the outer diameter and theinner diameter of the tubing, the greater the expansion ratio for theouter wall. The smaller the difference between the outer diameter andthe inner diameter of the tubing, the outer wall experiences greatermolecular orientation.

A problem encountered in the art is optimizing the radial stretch of theballoon tubing. In view of the non-uniform stretch between the innerwall and the outer wall of the tubing, some embodiments aim to optimizethe molecular orientation of the inner wall. The highest hoop stress ison the inner wall of the balloon where the molecules are at the maximumorientation level. On the inner wall, there is very little radialstretchability. While moving through the balloon towards the outer wall,the molecules are not at the maximum orientation level. On the outerwall, there is more radial stretchability since the outer wall wasexpanded radially by a lesser amount (e.g., expansion ration of 3.8compared to the optimal expansion ratio of 6.2 in the previous example).

The differences in molecular orientation relate to balloon failure. Insome instances, balloon rupture starts from the inner wall. The innerwall experiences the highest radial stresses (e.g., maximum expansion).Before final burst failure, micro tears or stress cracks will startforming on the inner wall of the balloon. Any additional forces, shearstresses or uneven force transfer from inner wall will accelerate themicro tear forming. The outer wall is not at the maximum orientationlevel (e.g., expansion ration of 3.8 compared to the optimal expansionratio of 6.2 in the previous example). Therefore, any additional forces,shear stresses or uneven force transfer will cause the outer wall tostretch thus providing no additional strength to the balloon. Balloonburst strength can be substantially improved by modifying the innerwall. In some embodiments, the balloon is formed from layers havingdifferent material properties. The inner wall can be a surface of aninner layer of softer, more stretchable material to act as stress crackmitigating layer. The inner layer can also be radially stretched tooptimize the strength and orientation of the inner layer. For instance,the balloon mold can be designed such that the inner wall reaches fullor substantially full molecular orientation. By delaying or mitigatingstress crack formation, the balloon burst strength can be substantiallyincreased. Magnitude of the increase can be as much as 25% or moredepending on the thickness of the tubing, diameter of the balloon, andthe material selected, among other characteristics of the balloon.

As shown in the stress-strain curve in FIG. 12, the outer wall isunder-stretched when optimizing radial stretch based upon the inner wallof the balloon. When the inner wall achieves optimal alignment of itspolymer chains, as shown on the stress-strain curve, the outer wall hasnot yet reached optimal alignment of its polymer chains, as shown bybeing further down the stress-strain curve of FIG. 12. If the inner wallof the balloon fails, the outer wall will continue to stretch thusproviding no additional strength to the balloon. In contrast, if theouter wall stretch is optimized, then the inner wall is over stretched.Consequently, the inner wall will develop micro-tears which can lead topremature failure of the balloon. Therefore, in some embodiments, thedesign of the balloon optimizes the radial stretch based on the innerwall rather than the outer wall.

The relative under-stretching of the outer wall can be substantial. Thiscan be shown using a mathematical model relating the radial expansion ofa smaller-diameter hollow cylinder with a given wall thickness (theinitial extruded tube) to a hollow cylinder with a larger diameter andthinner walls (the blow molded balloon body). FIG. 13 shows the variousradii to be taken into account from a cross section of the tube andballoon. Of particular interest will be the inner wall stretch(S_(i)=R_(i)/r_(i)) and the outer wall stretch (S_(o)=R_(o)/r_(o)). AsS_(i) is given as being the optimized radial stretch, the relative ratioof S_(o)/S_(i) will used to demonstrate the confounding effect of radialstretch on uniform wall strength. The stretch of the circumference canalso be described as radial stretch. The inner wall stretch can bedenoted as (S_(i)=2πR_(i)/2πr_(i)=R_(i)/r_(i)) and the outer wallstretch (S_(o)=2πR_(o)/2πr_(o)=R_(o)/r_(o)). As the best approach toballoon design is to optimize the inner wall stretch, S_(i) isconsidered to be a given. We must now determine r_(o) and S_(o) for theballoon.

To fully understand the effect of biaxial stretching on the crosssection, both the tubing and the balloon are considered cylindrical.Formula I, set forth below, shows the equation for the mass (M) of ahollow cylinder based on outer radius of the tube (r_(o)), inner radiusof the tube (r_(i)), length (L) and density (φ.

In expanding the hollow cylinder represented by the tube to a balloon,the mass remains the same, as shown in Formula II set forth below. Theparameters with the subscripted t refer to the tubing and thesubscripted B refers to the balloon. The length, outer radius, innerradius and possibly the density may change. Since the mass remains thesame, there is a fixed relationship between the radii of tube to that ofthe balloon as shown in Formula III.

M=π(r _(o) ² −r _(i) ²)Lρ  I.

M _(i) =M _(B)  II.

π(r _(o) ² =r _(i) ²)L _(t)ρ_(t)=π(R _(o) ² −R _(i) ²)L _(B)ρ_(B)  III.

Thus, for a balloon of a given diameter (2R_(o)) and wall thickness(W_(b)) with an optimized inner wall stretch (S_(i)), there is aspecific tube size that must be used as a starting condition. For agiven balloon, the required inner radius for the tubing is simply theballoon outer radius less the wall thickness divided by the optimalstretch for the polymer used: r_(i)=(R_(o)−W_(b))/S_(i). Determining theouter tubing radius, r_(o), is more complicated but can be derived fromthe equation in Formula III.

As set forth below, Formula IV shows such a derivation with S_(L) beingused to express the longitudinal stretch (S_(L)=L_(B)/L_(t)). Therelative longitudinal stretch, S_(L), can be expressed as the ratio ofballoon body length to tube length. The variable ρ represents therelative change in density (ρ=ρ_(B)/ρ_(t)). With these two equations,S_(o) and S_(i) can be calculated and the confounding effect of radialstretch shown. Formula IV can determine the outer diameter of the tubingbased on the outer diameter of the balloon and the wall thickness.

r _(o)=√{square root over (S _(L)ρ(2R _(o) W _(B) −W _(B) ²)+(R _(o) −W_(B))² /S _(i) ²)}  IV.

Formula V can determine the degree of outer wall stretch, S_(o), as afunction of wall thickness for a given balloon with specific outerradius (R_(o)), longitudinal stretch (S_(L)), density (φ, wall thickness(W_(b)), and inner wall stretch (S_(i)).

$\begin{matrix}{S_{0} = {\frac{R_{o}}{\sqrt{{S_{L}{\rho \left( {{2R_{o}W_{B}} - W_{B}^{2}} \right)}} + {\left( {R_{o} - W_{B}} \right)^{2}/S_{i}^{2}}}}.}} & V\end{matrix}$

Formula V can be used to evaluate the ratio of the outer wall stretch tothe inner wall relative to increasing wall thickness for a variety ofballoons. FIG. 14 shows the ratio of S_(o)/S_(i) as a function of wallthickness for different diameters of balloons. As can be seen, therelative under-stretching of the outer wall can be substantial. Forexample, the outer wall for a 2 mm balloon with a wall thickness of0.001 inches has been stretched less than 40% relative to the innerwall. Any increase in wall thickness to try to strengthen the wall showsa further decrease in relative stretching. The same 2 mm balloon with a0.002 inch wall thickness shows an outer wall stretch of less than 30%.The net result is that trying to increase wall thickness to increasebursting pressure gives diminishing returns in relation to outer wallstretch. Further, a thicker balloon wall causes a greater disparity inthe level of molecular orientation between the outer wall and the insidewall, as described herein. Therefore, increasing the wall thickness fora specific balloon diameter causes a decrease in the ratio of outer wallstretch to inner wall stretch (S_(o)/S_(i)). This suggests a diminishingreturn for increasing wall thickness to achieve a higher burst pressure.

FIG. 14 also shows that thin walled balloons (e.g., with thicknessesapproximately 0.005) have a greater ratio of S_(o)/S_(i) for largerdiameter balloons. For instance, 2 mm balloon has a relative outer wallstretch of greater than 50%. The 10 mm balloon has a relative outer wallstretch of greater than 80%. The larger diameter balloons (e.g., 10 mmor more) have a better distribution of stretch ratios between the innerand outer walls. This distribution may help to counter-balance theincreasing hoop stress that comes with increasing diameter.

The formulas can also be used to view the relative stretch within theballoon wall itself. Turning now to FIGS. 15 and 16, the confoundingeffect of radial stretch can be shown in more detail by examining thedistribution of relative stretch within the wall. This can be done by“mapping” the respective wall slice in the tube to that of the balloon.FIG. 15 shows such a map in which the inner wall has a position of 0%and the outer wall has a position of 100%. By calculating the stretch ofa slice for the tube wall, for example the 20% line, to the equivalentslice in the balloon, the distribution of relative radial stretch can beshown. FIG. 16 shows a graph of a representative balloon with therelative stretch ratio as a function of wall slice. As can be seen, thefalloff in relative stretch is not linear. The relative stretch in factdecreases more quickly from the inner wall.

The following model evaluates the effect of decreasing the ratio outerwall stretch to inner wall stretch (S_(o)/S_(i)) with increasing wallthickness on wall strength, W_(s). Formula VI shows the relationship.

W _(s) =W _(b) *S _(o) /S _(i)  VI.

FIG. 17 shows an ideal wall, where wall strength increasesproportionally with increasing thickness. However, the stretch ratio ofthe balloons decreases with the increase of thickness, as shown in FIG.14. Therefore, due to the influence of the stretch ratio, the wallstrength is substantially reduced relative to the ideal wall. Forsmaller diameter balloons, (e.g., 2 mm balloons), wall strength isreduced relative to the ideal wall even at the smallest wall thickness(e.g., below 0.0005 in). For all balloon diameters, wall strength isreduced relative to the ideal wall strength at larger wall thicknesses.This is due in part to the under-optimization of the stretch of theouter wall for larger wall thicknesses. This suggests a diminishingreturn for increasing wall thickness to increase wall strength.

Some embodiments of nested balloons described herein emphasize the useof tubes of the same material, stretch properties and/or size. FIG. 18shows one example of a nested balloon 2. The nested balloon comprisesouter balloon A and inner balloon B. The balloons can be produced fromnested tubing of the same material or different material. As such, thetubes initially can have the same or a different inner radius (r_(i))and outer radius (r_(o)). In some embodiments, the tubes initially canhave the same inner radius (r_(i)). In some embodiments, the tubesinitially can have different inner radii (r_(i)). In some embodiments,the tubes initially can have the same outer radius (r_(o)). In someembodiments, the tubes initially can have different outer radii (r_(o)).In some embodiments, nesting could in some cases produce significantly aweaker outer balloon based on the confounding effect of radial stretch.

In the manufacturing of the balloon, an outer diameter D of the balloonis selected based on the mold. The diameter can be selected to optimizethe stretch of the inner wall of the inner balloon B, as describedherein.

The inner wall of the inner balloon B reaches the point of optimalstretch. The inner balloon B cannot be further stretched without causingthe inner balloon B to burst. Therefore the outer walls of the innerballoon B can be under-stretched. Additionally, the balloons A, B can beidentical. Therefore, the inner walls and the outer walls of the outerballoon A can be under-stretched.

This problem may not be solved in some cases by co-extruding the balloonsuch that balloons A, B are integrally formed. The problem of innerballoon bursting can sometimes occur with co-extruded multi-layerballoons because the inner layer necessarily has a more optimized innerwall stretch compared to that of outer layer. This is shown in detail onFIG. 19, in which the relative stretch of the wall slices of a duallayer balloon made from co-extruded tubing is shown relative to a singlewall balloon having the same overall wall thickness. As shown in FIG.19, the outer layer shown with triangular markers is significantly lessstretched than that of the inner layer, as shown by the square markers.Some methods of creating multi-layer balloons primarily focus onco-extruding balloon elements in order to create a multi-layer balloon.The confounding effect of radial stretch may not be considered whenco-extruding a multi-layer balloon.

FIG. 20 shows the stress-strain curve for the nested balloon 2 havingtwo balloons A, B similar to FIG. 18 above. The inner balloon, innerwall is at the point of optimal stretch. The inner balloon, outer wallis under stretched. The inner wall of the outer balloon is understretched and the outer wall of the outer balloon is under stretched.Only the inner wall of the inner balloon has polymer chains that arealigned at the optimal stretch point. Pressurizing such a balloon willresult further growth and stretch of the polymer chains in anuncontrolled fashion, especially in absence of proper temperature anddimensional control.

The effect of the differential of inner wall stretch and outer wallstretch on burst strength can be demonstrated from internal productiondata, shown in FIGS. 21-23. Data including the average double wallthickness (DWT), hoop stress and burst pressure is produced for everylot. The graphs shown in FIGS. 21-23 are produced from production data.To simplify the following analysis, balloon lots are restricted to 6×40balloons, each made from nylon 12 but with varying wall thickness. Eachdata point is the average value for a production lot.

FIG. 21 shows that the average burst pressure relative to the doublewall thickness for 6 mm Nylon 12 balloons. The average burst pressureincreases with wall thickness in approximately a linear manner as shownby the best fit line. The average burst pressure (ABP) represents aspecific property of the material.

FIG. 22 shows the maximum hoop stress relative to the double wallthickness for 6 mm Nylon 12 balloons. Formula VII represents the maximumhoop stress, which normalizes the average burst pressure to the balloondiameter and the double wall thickness.

$\begin{matrix}{{{Max}\; \sigma_{\theta}} = {\frac{{ABP}*D}{DWT}.}} & {VII}\end{matrix}$

For a material with uniform properties, the maximum hoop stress(Maxσ_(θ)) is a constant. However, as shown in FIG. 22, there is asignificant decrease in maximum hoop stress due to the confoundingeffect of radial stretch with respect to orientation as compared with amaterial with uniform properties. The dashed line shows the expecteduniform hoop stress. Each data point represents average value of thehoop stress for a production lot. The maximum hoop stress decreases withwall thickness in approximately a linear manner as shown by the best fitline.

FIG. 23 shows the average burst pressure relative to the double wallthickness for 6 mm Nylon 12 balloons. The dashed line shows the expectedaverage burst pressure given uniform hoop stress. Each data pointrepresents average value of the burst pressure for a production lot. Theaverage burst pressure decreases with wall thickness in approximately alinear manner as shown by the best fit line.

As shown in FIG. 23, there is a significant decrease in average burstpressure as compared with a material with uniform properties shown inthe dashed lines. The molecules in the outermost layers of the balloonwall can be only partially oriented and thus contribute less and less tothe load bearing capacity of the material. This can have a significantimpact on balloon design. The decreasing maximum hoop stress and averageburst pressure confirms a diminishing return on increasing the wallthickness to achieve higher burst pressures, as described herein.Additionally, thicker walls increase the catheter profile as well asdecrease the flexibility of the balloon, as described herein.

The nested balloons 2 described herein, in some embodiments, canovercome these deficiencies in a variety of ways. In some embodiments,the outer balloon A and the inner balloon B shown in FIG. 18 comprisedifferent materials. In some embodiments, the outer balloon A and innerballoon B shown in FIG. 18 have different inner radii. In someembodiments, the outer balloon A and inner balloon B shown in FIG. 18have different outer radii. In some embodiments, the inner wall of theouter balloon A and the inner wall of the inner balloon B are bothoptimized. In FIG. 20, the inner wall of the outer balloon A and theinner wall of the inner balloon B both reach the point of optimizationnear the bend in the stress-strain curve shown in FIG. 20. In someembodiments, the outer balloon A and the inner balloon B have a smallthickness (e.g., double wall thickness less than 0.0005″, less than0.0010″, less than 0.0015″, less than 0.0020″, etc.). The wall thicknesscan be selected to minimize the difference in optimization between theinner wall and the outer wall of each balloon A, B. For smallerthicknesses, the outer wall stretch can be closer to the bend in thestress-strain curve shown in FIG. 20.

In some embodiments, each balloon A, B of a nested balloon 2 is formedfrom a co-extruded tubing. FIG. 24 shows an embodiment of a co-extrudedtube with each layer made from different materials. The co-extruded tubecan comprises a plurality of layers, such as an inner layer and an outerlayer, or an inner, middle, and outer layer in some embodiments with atri-layer balloon. In some embodiments, the co-extruded tube can includeat least 3, 4, 5, or more layers. The layers can have differentmaterials or the same material. In some embodiments, the outer layer isformed from nylon. In some embodiments, the inner layer is formed fromPebax (polyether block amide). Other combinations are contemplated.

Each layer can be selected to optimize the inner wall stretch. Forinstance, the material, inner radius, and outer radius of each layer canbe selected to optimize the inner wall stretch of each layer. The innerwall of the nylon layer can be optimized as shown in the double arrowline. The inner wall of the pebax layer can be optimized as shown in thedouble arrow line. The outer wall of each layer can be closer to theoptimized stretch. This is due in part to each layer having a smallerthickness than an equivalent single layer balloon.

In some embodiments, each balloon A, B is formed from a co-extrudedtubing and the balloons A, B can be nested. In some embodiments, theinner wall of the inner layer (e.g., Pebax layer) of the inner balloon Bis optimized. The inner wall of outer layer (e.g., Nylon layer) of theinner balloon B is optimized. In some embodiments, the inner wall of theinner layer (e.g., Pebax layer) of the outer balloon A is optimized. Theinner wall of outer layer (e.g., Nylon layer) of the outer balloon B isoptimized. In some embodiments, only one balloon is formed fromco-extruded tubing. In some embodiments, both the outer balloon A andthe inner balloon B are formed from co-extruded tubing. In someembodiments, a third balloon is provided, see FIG. 7A. Each balloon 20,22, 24 can be formed from co-extruded tubing. Each balloon 20, 22, 24can have one or more layers. The inner wall of each layer can beoptimized. The material, inner radius, or outer radius of each layer canbe selected to optimize the inner wall of each layer. Each co-extrudedballoon can be produced using techniques known in the art. In someembodiments, one or more balloons can be made of a plurality of layers,e.g., produced using co-extrusion techniques. In some embodiments, bothlayers can be made of the same material, such as both Nylon layers orboth Pebax layers.

In the example above, discussing optimizing the radial stretch, a singleballoon can be produced from nylon tubing having an outer diameter of0.031″ and an inner diameter of 0.019″, with a wall thickness of 0.006″.The mold has an inner diameter of 0.118″ and the thickness of theballoon is negligible when inflated for ease of calculation. Theexpansion ratio for the outer wall is 3.8 and the expansion ratio of theinner wall is 6.2.

For a nested balloon 2 having an outer balloon A and an inner balloon B,the expansion ratios could be altered. In this example, the outerballoon A and the inner B have a wall thickness of approximate half of asingle balloon. The two balloons A, B could be produced from nylontubing having an outer diameter of 0.025″ and an inner diameter of0.019″, for a wall thickness of 0.003″. The wall thickness is halfbecause two balloons are used. In the case of three balloons 20, 22, 24shown in FIG. 7A, the wall thickness could be cut by a third.

As in the previous examples, the expansion ratio of the inner wall isoptimized at 6.2. In the example of two balloons A, B, the expansionratio for the outer wall is 4.2, which is higher than the expansionratio for the outer wall of the single balloon (e.g., 3.8).

The nested balloon 2 has many potential synergistic advantages, in someembodiments. The nested balloon 2 has two balloons A, B, each having anoptimized inner wall. The nested design produces highly orientedmaterial on the two inner walls. The nested balloon 2 has two balloonsA, B, each having outer walls with a higher expansion ratio than asingle balloon having the same overall thickness. The nested designproduces a higher level of molecular orientation of the two outer walls.The higher expansion ratio relates to the increased stretching whichaligns molecular chains. Further, each tube which forms the balloon A, Bhas a smaller thickness (e.g., half of the overall thickness as comparedto a single balloon). A thinner tube causes less disparity in the levelof molecular orientation between the outer wall and the inner wall ofthe balloon. Thus multiple thin balloons nested together willunexpectedly and advantageously provide greater strength due in part tothe higher level of molecular orientation of the outer wall, than asingle balloon of equal thickness.

The properties of each balloon A, B within a nested balloon 2 areselected to optimize the stretch of the inner wall. In some embodiments,three balloons are provided, balloons 20, 22, 24 as shown in FIG. 7A. Insome embodiments, each balloon comprises two or more layers as shown inFIG. 24. The properties of each layer are selected to optimize thestretch of the inner wall of each layer. For instance, the balloons A,B, 20, 22, 24 or balloon layers may be sized differently. In someembodiments, the balloons A, B, 20, 22, 24 or balloon layers havedifferent diameters. In some embodiments, the balloons A, B, 20, 22, 24or balloon layers have different lengths. In some embodiments, theballoons A, B, 20, 22, 24 or balloon layers have different tubethicknesses. In some embodiments, the balloons A, B, 20, 22, 24 orballoon layers have different inner radii of the tube. In someembodiments, the balloons A, B, 20, 22, 24 or balloon layers havedifferent outer radii of the tube. In some embodiments, the balloons A,B, 20, 22, 24 or balloon layers have different inner radius of theinflated balloon. In some embodiments, the balloons A, B, 20, 22, 24 orballoon layers have different outer radius of the inflated balloon.

Therefore, the inner wall of each balloon or the inner wall of eachballoon layer can reach a point of optimal stretch. The outer walls ofeach balloon are more optimal than a single balloon having the samethickness as the nested balloon 2. The outer walls of each layer aremore optimal than a single balloon having the same thickness as thenested balloon 2.

The balloons A, B, 20, 22, 24 or balloon layers may have differentmaterial properties. In some embodiments, the balloons A, B, 20, 22, 24or balloon layers have different materials. In some embodiments, theballoons A, B, 20, 22, 24 or balloon layers have different densities.The present application, in some embodiments, contemplates selectingdifferent stretch properties for the balloons A, B, 20, 22, 24 orballoon layers, one greater than the other, to allow one balloon to benested in another balloon. Utilizing different balloons allows thestretch of the inner wall of each balloon or balloon layer to beoptimized, while making the stretch of the outer wall as optimal aspossible. Therefore, the nested balloon 2 will have at least a firstballoon A, 20 and a second balloon B, 22. Nesting one balloon within theother balloon produces two optimized inner walls and two highly-orientedouter walls.

If the first balloon and the second balloon comprise co-extrudedballoons having two layers each, then the number of optimized walls canincrease. The first balloon A, 20 can have an inner layer with anoptimized inner wall and an outer layer with an optimized inner wall.The second balloon B, 22 can have an inner layer with an optimized innerwall and an outer layer with an optimized inner wall. The first balloonA, 20 can have two optimized inner walls. The second balloon B, 22 canhave two optimized inner walls. Each balloon layer of the balloons A, B,20, 22 can have an optimized inner wall.

If the first balloon and the second balloon comprise co-extrudedballoons having two layers each, then the number of highly orientatedwalls can increase. The first balloon A, 20 can have two highly-orientedouter walls. The second balloon B, 22 can have two highly oriented outerwalls. Each balloon layer of the balloons A, B, 20, 22 can have anhighly oriented outer wall. Nesting one co-extruded balloon within theother co-extruded balloon can produce four optimized inner walls andfour highly-oriented outer walls. This, in some cases, greatly increasesthe strength of the nested balloon 2. In some embodiments, the stretchand/or orientation of inner layers can be optimized. In someembodiments, the stretch and/or orientation of outer layers can behighly-oriented. However, in some embodiments, only the stretch and/ororientation of one of the inner and/or outer layers are optimized.

FIG. 25 shows data related to a nested co-extruded balloon 2. FIG. 25shows that the average burst pressure relative to the double wallthickness for 6 mm Nylon 12 balloons. The average burst pressureincreases with wall thickness in approximately a linear manner as shownby the bolded best fit line. FIG. 25 includes the data presented in FIG.21. FIG. 25 includes additional data points. One data point representsthe average burst pressure of a 6 mm Nylon 12 single balloon with adouble wall thickness of approximately 0.005″, shown as a diamondsymbol. The reference single balloon had a burst pressure of 31 atm. Theother data points represents the average burst pressure of the nestedco-extruded balloon 2, shown as triangles. One data point correspondswith a nested co-extruded balloon with a double wall thicknessapproximately 0.005″, similar to the reference single balloon. Thenested balloon resulted in burst pressure of 49 atm-almost 60% greaterthan the reference single balloon. FIG. 25 includes another data pointfor a nested co-extruded balloon with a thinner double wall thickness ofapproximately 0.0036″. The 38 atm average burst pressure isapproximately 40% higher than the extrapolated burst pressure from thesingle layer balloons at a similar double wall thickness. FIG. 25suggests that nested co-extruded balloons have higher burst pressurethan single layer balloons having the same wall thickness. In someembodiments, the increase in burst pressure is at least 5%, at least10%, at least 15%, at least 20%, at least 25%, at least 30%, at least35%, at least 40%, at least 45%, at least 50%, at least 55%, at least60%, at least 65%, at least 70%, at least 75%, at least 80%, at least85%, at least 90%, at least 95%, at least 100%, greater than that of asingle balloon having the double wall thickness equal to combinedthickness of the nested co-extruded balloon.

FIG. 26 shows data related to a nested co-extruded balloon 2. FIG. 26shows the maximum hoop stress relative to the double wall thickness for6 mm Nylon 12 balloons. The maximum hoop stress decreases with wallthickness in approximately a linear manner as shown by the best fitline. FIG. 26 includes the data presented in FIG. 22. FIG. 26 includesadditional data points. One data point represents the maximum hoopstress of a 6 mm Nylon 12 single balloon with a double wall thicknessapproximately 0.005″, shown as a square symbol. The reference singleballoon had a maximum hoop stress around 1,450 atm. The other datapoints represents the maximum hoop stress of the nested co-extrudedballoon 2, shown as triangles. One data point corresponds with a nestedco-extruded balloon with a double wall thickness equal to the referencesingle balloon. The nested balloon resulted in a maximum hoop stress of2,350 atm-almost 40% greater than the reference single balloon. FIG. 26includes an additional data point for a nested balloon with a thinnerwall thickness of approximately 0.0036″. The ≈2,500 atm maximum hoopstress is approximately 40% higher than the extrapolated maximum hoopstress from the single layer balloons at a similar double wallthickness. FIG. 26 indicates that nested co-extruded balloons, in somecases, can have higher maximum hoop stress than single layer balloonshaving the same wall thickness. In some embodiments, the increase inmaximum hoop stress is between about, or at least about, 25%-55%,30%-50%, 35%-45%, or more greater than that of a single balloon havingthe double wall thickness equal to combined thickness of the nestedco-extruded balloon. In some embodiments, the increase in maximum hoopstress is at least 5%, at least 10%, at least 15%, at least 20%, atleast 25%, at least 30%, at least 35%, at least 40%, at least 45%, atleast 50%, at least 55%, at least 60%, at least 65%, at least 70%, atleast 75%, at least 80%, at least 85%, at least 90%, at least 95%, atleast 100%, or more greater than that of a single balloon having thedouble wall thickness equal to combined thickness of the nestedco-extruded balloon.

As shown in FIGS. 25 and 26, the majority of 6 mm Nylon 12 balloons havea double wall thickness in the range of 0.0015″ to 0.0030″. Balloonshaving a double wall thickness greater than 0.0030″ are in some casesnot desirable as they can be difficult to flute and wrap due to thestiffness of the wall. The individual balloons of the nested balloon 2can in some embodiments have a double wall thickness of 0.0025. In someembodiments, the first balloon 20, A of the nested balloon 2 has athickness that is approximately one-half the thickness of the singleballoon. In some embodiments, the second balloon 22, B has a thicknessthat is approximately one-half the thickness of the single balloon.Other configurations are contemplated.

In accordance with some embodiments, in order to substantially increasethe overall wall strength of a nested balloon, each balloon or balloonlayer is molded from tubing in which in the inner wall stretch has beenoptimized for maximum strength. FIG. 27 shows the relative stretch ofwall slices for a single wall balloon compared to a co-extruded balloonhaving two layers. The first layer of the co-extruded balloon has aninner wall that has been optimized, shown with square symbols. Thesecond layer of the co-extruded balloon has an inner wall that has beenoptimized, shown with triangle symbols. Each layer has been designed tooptimize the stretch of the inner wall. This is in contrast to FIG. 19.In FIG. 19, the second layer of the co-extruded balloon was not designedto optimize the inner wall of the second layer. As can been seen, therelative amount of optimally stretched material is greater than shown inFIG. 19.

The graph would be similar for two balloons molded from tubing in whichin the inner wall stretch has been optimized for maximum strength (notshown). The first balloon of the nested balloon would have an inner wallthat has been optimized, similar to the square symbols. The secondballoon of the nested balloon would have an inner wall that has beenoptimized, similar to the triangle symbols. Each balloon can be selectedto optimize the stretch of the inner wall.

Each balloon or balloon layer is made such that the inner wall has beenstretched for maximum strength, with the stretch ratio specific for thatparticular material. As described above, the inner wall can be stretchedto within about 15% of its optimal stretch and, in some applications,such as to within less than 10% of its optimal stretch. As the wallstrengths are additive, the burst pressure will be higher than that forany individual balloon.

A drawback of increasing balloon wall thickness to reach higher burststrength is reduced flexibility. The flexibility of the balloon can bedrastically reduced with increasing wall thickness. Nested balloons canhave several times better flexibility then a single wall balloon ofequivalent thickness, as shown in FIGS. 7A, 7B, 8A, and 8B. An idealnested balloon would have an infinite number of infinitely thinballoons. This would provide maximum achievable strength and maximumachievable flexibility. For practical purposes, such as complexity ofassembly and manufacturing cost, the number of balloons is typicallylimited to a few balloons (e.g., less than five, between two and five,less than four, between two and four, less than three, two or three).Substantial performance improvement over prior art balloons can beachieved with a nested balloon being made of two or more balloons. Insome embodiment, each balloon to be nested can be made of one, two, ormore layers. If a balloon to be nested is made of two or more layers, itcan be formed via a co-extrusion process.

FIGS. 28A and 28B illustrate a balloon wall element 14 of a nestedballoon catheter 2. To maintain flexibility, friction between eachballoon 20, 22, 24 should be minimized. To illustrate this point weconsider a balloon wall element 14. This element 14 has a thickness t,and a small width b and a length 1. The element 14 can be configuredeither axially or radially. Taking one end of the element 14 as fixed,the element 14 can be viewed as a cantilevered beam for analyticalpurposes, as described below in FIGS. 29A through 29D.

FIG. 29A shows the balloon element 14 with thickness t. A balloonelement 14 with thickness t requires a force F₁ to bend the element 14 aset distance y. FIG. 29B shows the balloon wall element 14′ withthickness 3t. This thicker element 14′ requires a force F₂, which istwenty-seven times larger than F₁, to bend the element 14′ the samedistance y as the element 14 in FIG. 29A (that is, because the forcerequired varies as a cube of the element thickness).

FIG. 29C shows a nested element 14″ comprised of a first element 15corresponding to the first balloon 20, a second element 16 correspondingto the second balloon 22, and a third element 17 corresponding to thethird balloon 24. Each of the elements 15, 16, and 17 has an individualthickness t. As a result, the nested balloon element 14″ has acumulative thickness 3t. Each sub-element 15, 16, and 17 is individuallyas thick as the balloon element 14 in FIG. 29A, but collectively asthick as the balloon element 14′ in FIG. 29B. Each individual element inFIG. 29C requires a force F₁ to bend a single balloon element a givendistance y. Collectively, the balloon element 14″ requires a force F₃ tobend the element 14″ a given distance y, which is three times as largeas the force Fi in FIG. 29A, but only one third as large as the force F₂in FIG. 29B. As shown in FIG. 29C, each element 15, 16, and 17preferably slides relative to the other elements a distance Δl. If theballoon element 15, 16, and 17 are not permitted to slide, then thenested balloon 14 will likely require the equivalent force F₃ shown inFIG. 29B.

Referring now to FIG. 29D, because the elements 15, 16, and 17 are inclose contact with each other and there is a potentially strong forcepushing them together, frictional effects can be very significant andprevent sliding between the balloons. To minimize friction betweenadjacent balloons and to allow sliding, layers 12, 13, 14 can be addedto elements 15, 16, and 17. In some embodiments, the layers are formedin a co-extrusion process such that the balloons 20, 22, 24 areco-extruded balloons. In some embodiments, the inner layer of the firstballoon 20 includes a sliding layer. In some embodiments, the innerlayer of the second balloon 22 includes a sliding layer. In someembodiments, the outer layer of the second balloon 22 includes a slidinglayer. In some embodiments, the outer layer of the third balloon 24includes a sliding layer. Other configurations are contemplated. Thelayers 12, 13, 14 can be made of any suitable substance, nonexclusivelyincluding biocompatible material. In some embodiments, the material isPebax (Arkema polyether block amide). It should be noted that layers arenot necessary when friction between balloons is allowable and, in someapplications, desirable.

To produce the layers, one or more of the balloons 20, 22, 24 may beformed from co-extrusion. The primary goal of the tubing coextruded fromdifferent types of material is to provide different surface propertieseither on the outside or the inside of the balloon. For example, thetubing can be coextruded in a combination of materials. In someembodiments, a coextruded balloon comprises an outer layer of Pebax forstrength. In some embodiments, a coextruded balloon comprises an middlebonding layer of Plexar. In some embodiments, a coextruded ballooncomprises an inner layer of HDPE for low coefficient of friction. FIG.24 shows another embodiment. In some embodiments, a coextruded ballooncomprises an outer layer of nylon. In some embodiments, a coextrudedballoon comprises an inner layer of Pebax. Other configurations arecontemplated. Additionally, the application of the balloon may dictatethe material. For instance, dilation balloons for heavily calcifiedlesions or areas where fine bone fragments may be encountered, such asrhinoplasty, may require balloons with a tough outer layer that has highabrasion, scratch and cut resistance. This can be accomplished byco-extruding an outer layer made of polyurethane. Stent deliveryballoons may require balloons with a softer outer layer with a highcoefficient of friction to improve the stent retention.

One goal is to provide the highest achievable burst strength withballoon compliance below about 10, 9, 8, 7, 6, 5, 4, 3%, or less andballoon wall thickness that is compatible with the smallest size ofintroducer for that specific balloon size. To achieve this goal, eachindividual balloon can have a high burst pressure to wall thicknessratio. This can be accomplished via material selection. In someembodiments, a coextruded balloon comprises Nylon 12 tubing with thestress crack mitigation layer of Pebax on the inside. The Pebax layeralso provides a secondary benefit of reduced friction at a boundarywhere the inner balloon touches the outer balloon. There can bealignment between the inner balloon and outer balloons both radially andaxially with no twisting of balloons with respect to each other. The lowballoon compliance is related to the level of material orientation. Twoor more thin walled balloons can have much higher average orientationthan one thick walled balloon, as described herein.

The balloons 20, 22, 24, A, B that form the nested balloon can be formedfrom parisons or from coextruded tubing. The outer layer of the ballooncan be made of high strength and hardness polyamide (nylon) that servesas the main load bearing layer. The inner layer can be made of lowerstrength and lower hardness material that also has a low coefficient offriction. One suitable material is Pebax (Arkema polyether block amide).In some embodiments, the material selected for the outer layer of theballoon and the inner layer of the balloon have the same orsubstantially the same melt temperature. The outer layer and inner layerof a single balloon can have a strong fused bond. The materialspolyamide and Pebax are closely related, and therefore coextrude welland fuse together at the boundary layer. In some embodiments, the Pebaxlayer is radially stretched and optimally oriented. This type of tubingprovides advantageous properties for forming individual balloons to beused in the nested balloon design.

During extensive testing, individual balloon formed from coextrudedtubing with outer main layer of Nylon 12 and inner layer of Pebax showedsuperior and unexpected results. The relative thickness can include, forexample, Nylon 12 70%, Pebax 30% (e.g., Nylon 12 50%, Nylon 12 greaterthan 50%, Nylon 12 60%, Nylon 12 greater than 60%, Nylon 12 70%, Nylon12 greater than 70%, Nylon 12 80%, Nylon 12 greater than 80%, Nylon 1290%, Nylon 12 greater than 90%, Nylon 12 between 60% and 80%, Nylon 12between 50% and 90%). The inner layer of Pebax functions as a stresscrack mitigation layer that delays the onset of micro tear formation.The inner layer of Pebax also functions as a lubricious layer due to itslower hardness and lower coefficient of friction as compared to Nylon12. Other suitable materials are contemplated.

FIGS. 30A through 30D generally depict a method for nesting balloons toform a nested balloon. Each balloon can be made, in some embodiments, ofone material, a blend, or co-extruded to comprise two or more layers asdescribed herein. As shown in FIG. 30A, an inner balloon 30 is providedhaving a proximal neck 50A and a distal neck 51A. The inner balloon 30can be heated and stretched so that the diameter and cross-sectionalarea of the inner balloon 30 is decreased, while the length of the innerballoon 30 is at least partially increased, as shown in FIG. 30B.Heating and stretching the inner balloon 30 in this manner typicallyalters the alignment of the polymer molecules comprising the body of theballoon 30. In some methods, the inner balloon 30 can be then flutedusing known fluting methods so that the balloon 30 comprises a pluralityof flutes. In some methods, the inner balloon 30 can be then wrappedabout a catheter shaft. The fluted and wrapped inner balloon 30 isillustrated in FIG. 30C. The balloon 30 can be fluted and wrapped, forexample, using known fluting and wrapping machines. Embodiments of suchmachines can be found in U.S. Pat. No. 7,762,804 entitled “BalloonCatheter Folding and Wrapping Devices and Methods,” the contents ofwhich are hereby incorporated by reference in their entirety. Othersuitable balloon fluting and wrapping devices, however, can also beused.

With reference to FIG. 30D, the fluted and wrapped inner balloon 30 canbe inserted into an outer balloon 31. The outer balloon 31 may have thesame or different properties of the inner balloon 30. For instance, theouter balloon 31 may comprise different materials or reach the point ofoptimal stretch at a larger diameter. In some embodiment, the balloons30, 31 are comprised of tube stock that optimizes the inner wall stretchof the balloons 30, 31. In some embodiment, the balloons 30, 31 arecomprised of co-extruded tubing that optimizes the inner wall stretch ofinner layers of the balloons 30, 31 and the inner wall stretch of theouter layers of the balloons 30, 31.

The outer balloon 31 has a proximal neck 50B and a distal neck 51B. Insome embodiments, the proximal neck 50B and the distal neck 51B of theouter balloon 31 have larger diameters than the proximal neck 50A anddistal neck 51A of the inner balloon 30. In some embodiments, the innerballoon 30 can be inserted into the outer balloon 31 by drawing itthrough the outer balloon 31 such that the inner balloon 30 issubstantially contained within the outer balloon 31. Other suitablemethods can also be used to insert the inner balloon 30 into the outerballoon 31.

The nested balloons 30, 31 are next heated, stretched, and inflated tobring the respective body portions of the inner balloon 30 and the outerballoon 31 into the same, or a substantially similar, molecular andgeometric alignment. Embodiments of devices capable of inflating andheating a balloon can be found in U.S. Pat. No. 7,578,165 entitled“Measurement Apparatus and Methods for Balloon Catheters,” the contentsof which are hereby incorporated by reference in its entirety. Theembodiments presented can be modified to stretch the balloon as well,and also can be used to verify that the balloons have been stretched toan optimal size and shape. Other embodiments can be used to heat,stretch, and inflate the nested balloons disclosed herein.

In some embodiments of the nesting method, one can heat and stretch theballoon and then begin inflating the balloon while continuing to heatand stretch the balloon. Inflation of the balloon can commence, forexample, when approximately thirty percent of the stretching remains tobe completed. The balloons are preferably stretched to 3-6×, 4-5×, about4×, about 4.5×, or about 5× their initial length in some cases. Thisamount of stretching is meant to optimize biaxial molecular alignment,and it will be apparent that a different method will be suitable fordifferent applications.

The nested balloon comprising the inner balloon 30 and the outer balloon31 can be fluted and wrapped in preparation for attachment to a cathetershaft. In some embodiments, the nested balloon is fluted and wrapped inpreparation for insertion into another balloon. In another embodiment,the nested balloon is fluted and wrapped in preparation for havinganother balloon inserted into a cavity defined by the nested balloon.

The above-disclosed nesting method is particularly suitable forultra-high pressure balloons having large neck diameters relative totheir body size. In some embodiments, one or more of the balloons to benested can have a neck diameter that is between about 10-80%, 20-70%,30-60%, 40-50%, 20-50% with respect to its balloon diameter at itsmidpoint, or at least about 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%,55%, 60%, 65%, 70%, 75%, 80% of the balloon diameter at its midpointwhile still being less than the balloon diameter at its midpoint.Further variations to the nesting method are possible such as, forexample, repetition of this process to produce nested balloons havingmultiple balloons (e.g., exactly or at least three, four, five, six,etc.).

In some embodiments of the present nesting method, the inner balloon 30and the outer balloon 31 are blow-molded on different molds. Theballoons 30, 31 can have substantially similar shapes along a bodyportion of the balloons 30, 31. In some embodiments, the balloons 30, 31can have proximal necks having different sizes or configurations. Insome embodiments, the balloons 30, 31 can have distal necks havingdifferent sizes or configurations. That is, the proximal and distalnecks 50A, 51A of the inner balloon 30 can have a different diameterthan the proximal and distal necks 50B, 51B of the outer balloon 31, asdescribed herein.

The above-disclosed method comprising independent formation of an innerballoon and an outer balloon and then nesting the balloons allows for avariety of balloon sizes and shapes. Therefore, this method canadvantageously allow for ideal balloon parameters for each individualballoon. However, in some instances, independent formation of balloonscould be a slower and more costly process, particularly for balloonswith small necks relative to their bodies. Typically, the body of theballoon is wider than its neck. However, the body of the inner balloonshould still be capable of fitting through the neck of the outerballoon. The body of a balloon can be narrowed by heating, stretching,fluting, and wrapping. The neck of a balloon can possibly be widened byheating and inflating or stretching the balloon radially, but thesemethods are limited. As a result, it is often practical to form balloonsindependently and then nest them to create nested balloons with aballoon body diameter to neck diameter ratio of about 7:1, 6:1, 5:1,4:1, 3:1, or less.

FIG. 31 shows a typical catheter for a nested balloon 2. The cathetersize is affected by the cross section area of the folded balloon and/orthe size of the proximal balloon neck weld. The introducer size can beminimized by minimizing the overall size of the catheter. Thus, tominimize the introducer and/or access greater regions of the humananatomy, the designer may try to minimize the balloon thickness and/orthe neck weld. The neck of the balloon may be specifically designed toensure optimal welding and/or attachment to the catheter. The locationof the proximal neck weld 4 relative to the nested balloon 2 and thecatheter 3 is shown in FIG. 31.

FIGS. 32A-32C show embodiments of the weld between the balloon and thecatheter. FIG. 32A shows a single balloon 2′ having an inner wall and anouter wall. In some embodiments, the thickness of the balloon 2′ neck is2t, and the thickness of the weld for the balloon neck and the proximalshaft is 3t, as shown. The thickness of the weld increases the size ofthe introducer needed for the balloon catheter. FIG. 32B shows a nestedballoons 2″ having two balloons. Each balloon can have an outer layerand an inner layer as shown. In some embodiments, the thickness of theballoon 2″ neck is 2t, and the thickness of the weld for the balloonneck and the proximal shaft is 3t, as shown. The thickness of the weldincreases the size of the introducer needed for the balloon catheter.The nested balloons 2″ can have multiple balloons and/or multiplelayers, providing benefits over the single layer balloon 2′ shown inFIG. 32A and described herein. However, the balloons 2′ and 2″ shown inFIG. 32A and FIG. 32B would require the same size of introducer.

FIG. 32C shows the weld of an embodiment of the nested balloon 2. Thenested balloon 2 comprises the first balloon 20 and the second balloon22, each with thickness t. Each balloon can have an outer layer and aninner layer, as described herein. The neck of the second balloon 22 canhave a smaller diameter and/or longer length than the neck of the firstballoon 20. The neck of the first balloon 20 can have a larger diameterand/or shorter length than the neck of the second balloon 22. The neckof the second balloon 22 can be welded to the catheter 3. The firstballoon 20 can be welded to the second balloon 22 at a location alongthe neck of the second balloon 22. The necks are partially or completelystaggered (e.g., offset). Therefore, the thickness of the balloon andthe catheter is 2t, not 3t as shown in FIGS. 32A-32B. The ballooncatheter shown in FIG. 32C would require a smaller introducer. Theconfiguration of the necks of the balloons 20, 22 produces a smaller, insome cases about 33% smaller bulge than the previous examples. Otherconfigurations of staggering the neck welds of the nested balloons arecontemplated.

FIGS. 33A-33B are graphs illustrating concepts described herein. Thegraphs compare a single balloon and a nested balloon. The nested ballooncomprises two balloons. Each balloon can be formed from co-extrudedtubing, having a first layer and a second layer. The graphs illustratethe superior and unexpected wall stretch properties of a nested ballooncomprising a co-extruded inner layer and a co-extruded outer layer at agiven wall thickness with respect to a single layer balloon having thesame wall thickness. As noted, each balloon in the nested balloon isdual-layer balloon manufactured from co-extruded tubing. Both the singleballoon and nested balloon have the same overall wall thickness.

FIG. 33A shows an embodiment where the inner layer of the first balloonand the inner layer of the second balloon are not optimized. As shown,the inner wall of the inner layer of the first balloon is only 80% ofthe optimized stretch. The inner wall of the inner layer of the secondballoon is only 80% of the optimized stretch. The inner layer cancomprise a stress crack mitigating layer, as described herein. The innerwalls of the inner layers are not optimized. The inner wall of the outerlayer of the first balloon is optimized. The inner wall of the outerlayer of the second balloon is optimized. The inner walls of the outerlayers are 100% of the optimized stretch.

FIG. 33A shows an embodiment where the inner wall of the outer layer ofeach balloon is optimized. The inner wall of the inner layer of eachballoon, which may be a stress crack mitigating inner layer, is notoptimized. In some embodiments, the inner wall of the inner layer of oneor more of the balloons forming a nested balloon need not necessarilyhave its wall stretch optimized. In such cases, the co-extruded nestedballoon can still retain the advantageous stress crack mitigating and/orlubricious properties of the inner layer.

In some embodiments, each inner wall of each inner layer of the nestedballoon is optimized. In some embodiments, each inner wall of each outerlayer of the nested balloon is optimized. In some embodiments, someinner walls of the inner layers of the nested balloon are optimized. Insome embodiments, some inner walls of the outer layers of the nestedballoon are optimized.

FIG. 33B shows an embodiment where the inner layer of the first balloonand the inner layer of the second balloon are optimized. As shown, theinner wall of the inner layer of the first balloon is close to, or at100% of the optimized stretch. The inner wall of the inner layer of thesecond balloon is close to, or at 100% of the optimized stretch. Theinner walls of the inner layers are optimized. The inner wall of theouter layer of the first balloon and the inner wall of the outer layerof the second balloon are also optimized. Each of the four inner wallsis close to, or at 100% of the optimized stretch. FIG. 33B shows anembodiment where both the outer layer and the inner layer of eachballoon is optimized.

Nested balloons can have several times better flexibility then a singlewall balloon of equivalent thickness. As shown in FIG. 29C, each element15, 16, and 17 preferably slides relative to the other elements adistance Δl. If the balloon element 15, 16, and 17 are permitted toslide, then the nested balloon will likely require less force to bend.For three elements of equal thickness, the force needed can approach thelimit of three times the force needed to bend a single element. Forthree elements of equal thickness, the force can approach the limit of athird less force than needed to bend a balloon with a single layer ofequivalent thickness to the three elements.

Nested balloons can be formed from co-extruded tubing. The tubing outerlayer can be made of high strength and hardness material. In someembodiments, the material is polyamide (nylon). In some embodiments, thestructural layers comprise a polyamide such as Nylon 12. The tubinginner layer can be made of lower strength and lower hardness material.The tubing inner layer can have a low coefficient of friction. In someembodiment, the lubricating layers comprise 0.0001 to 0.00015 inchhigh-density polyethylene. To maintain flexibility in the nestedballoon, friction between these balloons 20, 22, 24, A, B can beminimized.

Nested balloon can provide an additive strength of individual balloons.FIGS. 7A and 8A show an enlarged cross-section of an embodiment of thenested balloon 2 having the first balloon 20, the second balloon 22, andthe third balloon 24. In some embodiments, one or more of the balloon20, 22, 24 can comprise multiple layers. For instance, the first ballooncan comprise two or more layers, the second balloon can comprise two ormore layers and/or the third balloon can comprise two or more layers. Insome embodiment, in which the nested balloon 2 comprises a balloonhaving three structural layers, the balloon comprises an outer layer, amiddle layer, and an inner layer.

Because each balloon 20, 22, 24 is thinner than the single-layer balloonof FIGS. 7B and 8B, the bend radius 10 is smaller for an equalcumulative thickness 3t. Because the cumulative thickness of the nestedballoon 2 of FIG. 7A is substantially the same as the thickness of thesingle-layer balloon 2′, the burst pressure P would be anticipated to bethe substantially the same as long as adjacent balloon layers of thenested balloon can slide relative to each other. However, as shown inFIG. 25, the burst pressure is greater than the burst pressure of asingle-layer balloon having an equivalent thickness. FIG. 25 suggeststhat nested co-extruded balloons have higher burst pressure than singlelayer balloons having the same wall thickness. In some embodiments, theincrease in burst pressure is between about 25%-75%, 30%-70%, 35%-65%,40%-60% greater than that of a single balloon having the double wallthickness equal to combined thickness of the first balloon and thesecond balloon.

The nested balloon can comprise two or more balloons, each blown from aco-extrusion. Disclosed herein is a method for creating nested balloonswith low friction interfaces by nesting multiple balloons or by nestingco-extruded tubing. It will be apparent that these methods can becombined with each other and other balloon forming methods to producelarger multi-layer balloons. Similarly, the balloons need not be formedand processed identically to obtain equivalent burst strengths, sizes,and/or molecular orientations. This is especially true for balloons ofdifferent materials. In accordance with embodiments, each balloon ismolded from tubing in which in the inner wall stretch of each layer hasbeen optimized for maximum strength.

In some embodiment, each co-extruded tube can have at least two innerwalls of optimized stretch. Each co-extruded tube can have at least twoouter walls of highly oriented stretch. In some embodiments, materialsare selected with different stretch properties for the co-extrusion, onegreater than the other. In some embodiments, the co-extruded tubing issized based on optimizing that stretch. It will be apparent thatballoons of different material may require different sizes and shapes tooptimize the inner wall stretch. It will also be apparent that, becausethe balloons still do not stretch to exactly equal diameters uponinflation, it may be practical to make the inner balloons slightlysmaller such that each layer stretches to substantially near its optimalstretch. Using this design, it is not necessary that the layers be madefrom the same material or have the same wall thickness. Each layer ismade such that the inner wall has been stretched for maximum strength,with the stretch ratio specific for that particular material. The methodof nesting contemplates use of non-identically sized or shaped balloons.

In accordance with some embodiments, in order to substantially increasethe overall wall strength of a nested balloon, each balloon or balloonlayer is molded from tubing in which in the inner wall stretch has beenoptimized for maximum strength. FIGS. 33A-33B show the relative stretchof wall slices for such a nested balloon having two balloons formed fromco-extruded tubing.

Each balloon in the nested balloon can be manufactured from co-extrudedtubing. Each balloon in the nested balloon catheter has an outer layerand an inner layer, as described herein. In some embodiments, the innerlayer can be a lubricious, stress crack mitigating inner layer asdescribed herein. Other configurations are contemplated.

Embodiments of the nested balloon disclosed herein can provide asignificant and unexpected performance improvement over current highpressure balloons. The disclosed embodiments allow for balloon cathetersto be used in new applications. For example, nested balloons can be usedin ultra-high pressure applications such as 50 atmospheres or more forup to 10 mm diameter balloons, and for high pressure applications forvery large balloons such as 12 atmospheres or more for up to 30 mmdiameter balloons. The advantages provided by the nested balloonsdisclosed herein can be attributed, at least in part, to forming eachballoon from tubing where the inner wall stretch has been optimized formaximum strength, as well as the particular material choice for eachballoon making up the nested balloon.

As noted herein, there is a distinction between balloons produced fromnested tubing of the same material and nested balloons comprising aplurality of individual balloons. There can be a difference inperformance between the two as well as targeted applications.

Coextruded balloon tubing does not address the differences in materialmolecular orientation between the inner wall and the outer wall of theballoon. Some embodiments as disclosed herein improve the strength ofthe coextruded balloon by achieving more uniform orientation through theballoon wall. Multilayer balloons produced from coextruded tubing, insome embodiments, suffer from the same drawbacks as any single layerballoon in terms of disparities in orientation and lack of flexibility.In some embodiments, each layer of a co-extruded balloon is selected tooptimize the inner wall of each layer.

A nested balloon comprises two or more balloons formed independently andsubsequently inserted within each other. For nested balloon design,careful consideration must be given to the individual balloondimensions, including balloon cones and necks. The design enablesefficient and uniform load transfer from the inner balloon to the outerballoon with a minimum friction between balloon walls. Some importantelements include balloon sizing, alignment of the balloons, reducedfriction between balloon walls, and a stress crack mitigation layer. Theissue of stress crack (micro tear) formation is magnified by theinteraction of the inner and outer balloons during the force transfer.

Nested balloons can advantageously provide the additive strength ofindividual balloons. For example, if you have two balloons each withburst strength of 25 atm, then these balloons nested within each othershall provide theoretical strength of 50 atm. In reality this number canbe lower by 10% to 30% due to small inefficiencies in load transfer orload sharing by the individual balloons. In order to maximize theresults the balloons can be very precisely sized and aligned during thenesting process. In some embodiments, it is preferred to have a uniformcontact between the complete surfaces of inner and outer balloon withoutany voids or air pockets. Furthermore, it can be desirable to havecertain amount of lubricity between the layers so the balloons canself-align and compensate for small irregularities without creatingadditional stresses in the wall. The material selection of layers of theballoons can reduce friction. For example, the inner layer made of, forexample, Pebax as described herein can provide lubricity.

Nested balloons can provide benefit with respect to burst strength andflexibility. However they present unique challenges compared to singlelayer balloons. Two such challenges are Rated Burst Pressure (RBP) andcompliance.

The challenge with respect to RBP is that increased deviation in averageburst that can occur with nested balloons will result in a lower valuefor RBP. RBP is defined as the pressure at which 99.9% of balloons cansurvive with 95% statistical confidence. Failure of a balloon tomaintain integrity at the RBP could result, in device failure or luminaldamage. Typically a Minimum Burst Strength (MBS) is used which isgreater than the RBP to provide some cushion. MBS is calculated from theAverage Burst Pressure (ABP) less the Standard Deviation (SD) for theABP multiplied by the K factor. The K factor is based on one-sidedtolerance limits for normal distribution and is a function of confidencelevel, probability and sample size. For 95% confidence with 99.9%probability and a sample size of 30 the K factor is 4.022. As a resultsmall increases in SD can significantly impact the resulting MBS even ifthe ABP is the same:

MBS=ABP−(K*SD)

Historically, the SD for nylon balloons is approximately 4.5% and canrange from approximately 2% to 7% according to some embodiments, asshown in FIG. 34.

From a design point of view it can be desirable in some cases to designfor the top end to ensure lot to lot success.

% SD=SD/ABP.

ABP=MBS/(1−K*% SD)

One consequence is that SD increases with ABP, which can be significantfor high burst pressure requirements. Another is that nesting balloonscan increase the % SD.

Nested balloons increase the complexity over monolayer balloons. Eachlayer will have an ABP along with a SD. In addition the nesting itselfcontributes to the overall SD.

Nesting Effectiveness (NE) is a way of expressing the degree to whichnesting is effective. In the ideal case the ABP for the nested balloonswill be the sum of the ABP of two individual layers. Assuming bothlayers have the same ABP, the NE would be 2. If the NE is less thanabout 2, this indicates loss of burst strength. For example if theindividual balloon layers have an ABP of 25 atm and the nested balloonABP is 50 atm, this would be an NE of 2. If in the same case the ABP ofthe nested balloon is 40 atm, the NE is 1.6. Such loss in balloonstrength might result from a combination misalignment, micro-weldsbetween layers acting as stress risers or small differences in size, forexample.

The NE will not be a constant and will have its own standard deviationif measured across a population. This deviation will contribute to theoverall standard deviation of the nested balloon ABP. Compensating for ahigher % SD to achieve a specific MBS will require increasing the ABP.This is done by increasing the balloon wall thickness, which will offsetthe value of the nested balloons.

As noted, another challenge is that nested balloons can increase thecompliance of the balloon, which on the surface appearscounter-intuitive as increased layers is expected to decrease thecompliance due to increased level of highly oriented polymers. Thisdecreased compliance is a result of how compliance is stated for ballooncatheters and the typical compliance curve for a balloon.

Compliance is specifically the percent change in balloon diameter fromthe nominal pressure (NP) to RBP. By changing the NP and RBP for a givenballoon it's possible to increase or reduce the compliance withoutchanging the balloon itself. The values of NP and RBP are oftenmanipulated so as to achieve specific requirements for compliance. Thiscan be seen in the graph below where for a given RBP of 18 atm, thecompliance is 8.4% for an 8 atm nominal pressure while it is 6.6% for a10 atm nominal pressure. The graph below also sets the stage forexplaining why the compliance can decrease for a nested balloon.

The compliance curve shown in FIG. 35 is typical for nylon balloons,according to some embodiments. The compliance is bimodal in that theinitial compliance at lower pressures is higher than the primarycompliance curve at the higher pressures. The point at which thesepoints meet can be referred to as the Deflection Point (DP). Note thatthe DP is approximately 6 atm. Typically nominal pressures are in therange of 6 to 10 atm, so the higher initial compliance is not a factorwith respect to standard balloon compliance. However this is not thecase with respect to nested balloons.

FIG. 36 shows the compliance curve for nested balloons, according tosome embodiments. Since the pressure seen by the individual layers iseffectively halved, the initial compliance curve is spread over twicethe pressure range. In FIG. 36 the DP is at 12 atm, higher than thetargeted 10 atm nominal pressure. As a consequence the initial diameterfor calculating the standard balloon compliance is lower, resulting in agreater compliance value.

In some embodiments, both the balloon burst deviation and complianceissues have been mitigated to a substantial extent by a process hereindescribed, which can involve annealing a nested balloon under relativelyhigh pressures and/or temperatures, which advantageously andunexpectedly can allow for two, three, or more balloon layers nestedtogether, which can increase strength and improve (increase or decrease)compliance of the nested balloon, in some cases relative to a non-nestedballoon having the same properties (e.g., materials, diameter, etc.)

The process can include, in some embodiments, any number of thefollowing steps:

(a) Balloons blown and nested within a relatively short time period,such as within the same day (FN Fast Nesting), such as within about 48,36, 24, 20, 18, 16, 14, 12, 10, 8, 7, 6, 5, 4, 3, 2, 1, or less hours ofeach other.

(b) Nested balloons annealed in a mold can be annealed involving one,two, or more of the following parameters in some embodiments:temperature of: about 235° F., (or from about 100° F. to about 300° F.,from about 200° F. to about 300° F., from about 120° F. to about 270°F., from about 215° F. to about 255° F., or from about 215° F. to about255° F. in some embodiments, or ranges includes any two of the foregoingvalues), or below the upper end of the glass transition temperature ofthe balloon materials; pressure: about or at least about 2 atm, 5 atm,10 atm, 15 atm, or 20 atm (or about 2 to about 40 atm, about 5 to about30 atm, or about 15 to about 25 atm in some embodiments, at a minimumabove the nominal pressure of the balloon, or ranges including any twoof the foregoing values); 1-2 lbs stretch (about 0.5 to about 10 lbs,about 1 to about 5 lbs, or about 1 to about 3 lbs in some embodiments,or ranges including any two of the foregoing values); for about or atleast about 30 minutes (about 5 to about 180 minutes, about 5 to about90 minutes, about 10 to about 60 minutes, about 15 to about 45 minutes,or ranges including any two of the foregoing values). Such techniquessuch as described in some embodiments herein can be hereby referred toherein as PCA or Pressurized Constrained Annealing. In some embodiments,the annealing can occur in an enclosed, high pressure, balloon heatingchamber configured with a controller to allow for any number of theparameters described herein. A variety of balloon materials, diameters,and other characteristics can be utilized such as described elsewhereherein in some embodiments.

(c) Nested balloons can be welded to the inner and/or outer shaft of acatheter.

(d) “Sterilization” annealing at an appropriate temperature at anappropriate time, such as about 50° C. (for example, about 40° C. toabout 60° C.) for about 2 hours (for example, about 1 hour to about 3hours) in some embodiments.

The unexpectedly advantageous result can be a nested balloon that with alower compliance, both before and/or after annealing, and higher MBS asa result of lower % SD. FIG. 37 shows the change in diameter due to achange in pressure for non-annealed nested balloons, and FIG. 38 showsthe change the in diameter due to a change in pressure for annealednested balloons. The difference in the curve indicates that the balloonburst deviation and compliance issues can be mitigated to a substantialextent by annealing under relatively high pressures as disclosed herein.

In comparison, balloons without constrained pressurized annealing havelower burst pressure and higher compliance, as listed in the tablebelow:

Nested balloons not employing Fast Nesting, Constrained PressurizedAnnealing Annealed Yes No Nominal ø 10 10 RBP 32 32 DWT 0.0062 0.0054Avg BP 36.7 45.0 Compliance 12.7% 6.1% DP 19.26 16.89

It is contemplated that various combinations or subcombinations of thespecific features and aspects of the embodiments disclosed above may bemade and still fall within one or more of the inventions. Further, thedisclosure herein of any particular feature, aspect, method, property,characteristic, quality, attribute, element, or the like in connectionwith an embodiment can be used in all other embodiments set forthherein. Accordingly, it should be understood that various features andaspects of the disclosed embodiments can be combined with or substitutedfor one another in order to form varying modes of the disclosedinventions. Thus, it is intended that the scope of the presentinventions herein disclosed should not be limited by the particulardisclosed embodiments described above. Moreover, while the invention issusceptible to various modifications, and alternative forms, specificexamples thereof have been shown in the drawings and are hereindescribed in detail. It should be understood, however, that theinvention is not to be limited to the particular forms or methodsdisclosed, but to the contrary, the invention is to cover allmodifications, equivalents, and alternatives falling within the spiritand scope of the various embodiments described and the appended claims.Any methods disclosed herein need not be performed in the order recited.The ranges disclosed herein also encompass any and all overlap,sub-ranges, and combinations thereof. Language such as “up to,” “atleast,” “greater than,” “less than,” “between,” and the like includesthe number recited. Numbers preceded by a term such as “approximately”,“about”, and “substantially” as used herein include the recited numbers,and also represent an amount close to the stated amount that stillperforms a desired function or achieves a desired result. For example,the terms “approximately”, “about”, and “substantially” may refer to anamount that is within less than 10% of, within less than 5% of, withinless than 1% of, within less than 0.1% of, and within less than 0.01% ofthe stated amount.

What is claimed is: 1-18. (canceled)
 19. A method of manufacturing anested balloon, comprising: providing a first balloon; providing asecond balloon; inserting the first balloon into the second balloon toform a nested balloon, wherein the first balloon layer slides relativeto the second balloon layer before annealing; annealing the nestedballoon by pressurized constrained annealing to have a lower averageburst pressure and a higher compliance than a balloon not annealed,wherein the first balloon layer slides relative to the second balloonlayer after annealing; and blow-molding the first balloon layer and thesecond balloon layer prior to annealing.
 20. The method of claim 19,wherein annealing the nested balloon by pressurized constrainedannealing comprises annealing at a temperature of between about 100° F.and about 300° F. for a time period of at least 30 minutes.
 21. Themethod of claim 19, wherein the first balloon layer comprises nylon. 22.The method of claim 19, wherein the second balloon layer comprisesnylon.
 23. The method of claim 19, wherein annealing the nested balloonby pressurized constrained annealing comprises annealing at temperaturebetween about 120° F. and about 270° F.
 24. The method of claim 19,wherein annealing the nested balloon by pressurized constrainedannealing comprises annealing at temperature between about 100° F. andabout 200° F.
 25. The method of claim 19, wherein annealing the nestedballoon by pressurized constrained annealing comprises pressurizing thenested balloon at a pressure of between about 2 atm and about 30 atm.26. The method of claim 19, wherein annealing the nested balloon bypressurized constrained annealing comprises pressurizing the nestedballoon at a pressure of between about 15 atm and about 25 atm.
 27. Themethod of claim 19, further comprising stretching the balloon with astretch force of between about 1 pound and about 5 pounds.
 28. Themethod of claim 19, wherein annealing the nested balloon by pressurizedconstrained annealing for ae time period is between 30 minutes and 180minutes.
 29. The method of claim 19, further comprising sterilizing thenested balloon after annealing at a temperature of between about 40° C.and about 60° C. for a time period of between about 1 hour and about 3hours.
 30. The method of claim 19, wherein blow molding occurs no morethan about 48 hours prior to annealing.
 31. The method of claim 19,wherein blow molding occurs no more than about 24 hours prior toannealing.
 32. The method of claim 19, further comprising welding thenested balloon to a catheter shaft to form a balloon catheter.
 33. Themethod of claim 19, wherein the first balloon layer is a co-extrudedballoon layer.
 34. The method of claim 19, wherein the second balloonlayer is a co-extruded balloon layer.
 35. The method of claim 19,wherein the first balloon and the second balloon comprise the samematerial.
 36. The method of claim 19, wherein a lubricant is disposedbetween the first balloon and the second balloon.
 37. A method ofmanufacturing a nested balloon, comprising: providing a first balloon;providing a second balloon; inserting the first balloon layer into thesecond balloon layer to form a nested balloon, wherein a lubricant isdisposed between the first balloon layer and the second balloon layer,wherein the first balloon and the second balloon comprise the samematerial; blow-molding the first balloon layer and the second balloonlayer prior to annealing; annealing the nested balloon by pressurizedconstrained annealing to have a lower average burst pressure and ahigher compliance than a balloon not annealed, wherein the first balloonlayer and the second balloon layer are configured to slide relative toeach other after annealing.
 38. The method of claim 37, whereinannealing the nested balloon by pressurized constrained annealingcomprises applying the temperature between about 100° F. and about 300°F. for between 30 minutes and 90 minutes.